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General NPI Number Information
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NPI Number | 1033768411
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Entity Type | Organization
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Legal Business Name | TKM, INC
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Dates
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Enumeration Date | 09/09/2019
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Last Update Date | 09/09/2019
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Provider Practice Location Address
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Address Line | 21 MIDLAND ST
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City | HIGHLAND PARK
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State | MI
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Zip | 48203-3727
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Country | US
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Telephone | 313-221-6939
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Fax |
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Provider Business Mailing Address
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Address Line | 21 MIDLAND ST
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City | HIGHLAND PARK
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State | MI
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Zip | 48203-3727
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Country | US
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Telephone | 313-221-6939
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | WALLY SHERMAN MAHAR
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Credential | M.D.
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Telephone | 313-221-6939
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State |
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