Healthcare Provider Details

I. General information

NPI: 1558364562
Provider Name (Legal Business Name): DAVID C THORREZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 06/21/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 PACKARD RD STE 1
YPSILANTI MI
48197-2061
US

IV. Provider business mailing address

2900 PACKARD RD STE 1
YPSILANTI MI
48197-2061
US

V. Phone/Fax

Practice location:
  • Phone: 734-572-8686
  • Fax: 734-572-8866
Mailing address:
  • Phone: 734-572-8686
  • Fax: 734-572-8866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301035414
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: