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General NPI Number Information
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NPI Number | 1205266491
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Entity Type | Organization
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Legal Business Name | THOMAS KNUTH MD PA
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Dates
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Enumeration Date | 11/25/2013
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Last Update Date | 01/03/2014
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Provider Practice Location Address
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Address Line | 22101 MOROSS RD PROF BLD 1 SUITE 332
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City | DETROIT
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State | MI
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Zip | 48236-2148
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Country | US
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Telephone | 586-552-5333
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Fax | 586-552-5326
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Provider Business Mailing Address
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Address Line | PO BOX 806403
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48080-6403
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Country | US
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Telephone | 586-552-5333
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Fax | 586-552-5326
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. KATHY A VIVIANO
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Credential |
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Telephone | 585-552-5333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 4301089707
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License Number State | MI
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