=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346424447
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THORREZ MEDICAL PRACTICE PLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/26/2007
-----------------------------------------------------
Last Update Date | 03/14/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2900 PACKARD RD SUITE 1
-----------------------------------------------------
City | YPSILANTI
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48197-2060
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-572-8686
-----------------------------------------------------
Fax | 734-572-8866
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2900 PACKARD RD STE 1
-----------------------------------------------------
City | YPSILANTI
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48197-2061
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-572-8686
-----------------------------------------------------
Fax | 734-572-8866
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | KATHLEEN M MCCARREN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 734-572-8686
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 4301035414
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------