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General NPI Number Information
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NPI Number | 1588195739
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Entity Type | Individual
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Provider Name | MICHAEL TOMAK PHD, BCBA-D, LBA
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Gender | Male
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Dates
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Enumeration Date | 03/21/2017
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Last Update Date | 07/24/2023
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Provider Practice Location Address
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Address Line | 23200 RED ARROW HWY
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City | MATTAWAN
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State | MI
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Zip | 49071-7774
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Country | US
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Telephone | 269-355-6621
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Fax |
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Provider Business Mailing Address
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Address Line | 302 N JOHN ST
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City | DECATUR
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State | MI
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Zip | 49045-1365
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Country | US
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Telephone | 269-330-0696
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Fax |
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 7401000344
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License Number State | MI
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