=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699818617
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRUECARE ASTHMA AND ALLERGY CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/15/2007
-----------------------------------------------------
Last Update Date | 04/24/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 21700 NORTHWESTERN HIGHWAY SUITE 835
-----------------------------------------------------
City | SOUTHFIELD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48075-4902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-395-2273
-----------------------------------------------------
Fax | 248-395-3889
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 21700 NORTHWESTERN HWY SUITE 835
-----------------------------------------------------
City | SOUTHFIELD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48075-4906
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-395-2273
-----------------------------------------------------
Fax | 248-395-3889
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. THOMAS JAMES TRUEHEART JR.
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 248-395-2273
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207KA0200X
-----------------------------------------------------
Taxonomy Name | Allergy Physician
-----------------------------------------------------
License Number | 4301049422
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------