Healthcare Provider Details

I. General information

NPI: 1730121773
Provider Name (Legal Business Name): THOMAS J HURM D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 11/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 W MAIN ST SUITE 1
COLDWATER OH
45828-1656
US

IV. Provider business mailing address

809 W MAIN ST SUITE 1
COLDWATER OH
45828-1656
US

V. Phone/Fax

Practice location:
  • Phone: 419-678-2381
  • Fax: 419-678-2040
Mailing address:
  • Phone: 419-678-2381
  • Fax: 419-678-2040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34007343
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: