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General NPI Number Information
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NPI Number | 1336162122
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Entity Type | Individual
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Provider Name | ROBERT L TOMSAK MD, PHD
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Gender | Male
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 11/10/2015
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Provider Practice Location Address
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Address Line | 4717 ST ANTOINE KRESGE EYE INSTITUTE
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City | DETROIT
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State | MI
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Zip | 48201-1423
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Country | US
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Telephone | 313-577-8900
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Fax | 313-577-0700
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Provider Business Mailing Address
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Address Line | 1560 E. MAPLE RD SUITE 400-CREDENTIALING
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City | TROY
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State | MI
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Zip | 48083-1189
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Country | US
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Telephone | 248-581-5976
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Fax | 248-581-5640
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 35-043259
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 4301095698
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License Number State | MI
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