=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902132731
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AWOON PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/29/2009
-----------------------------------------------------
Last Update Date | 10/29/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2330 E STADIUM BLVD STE 2
-----------------------------------------------------
City | ANN ARBOR
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48104-4820
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-971-5483
-----------------------------------------------------
Fax | 734-971-7585
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2330 E STADIUM BLVD STE 2
-----------------------------------------------------
City | ANN ARBOR
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48104-4820
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-971-5483
-----------------------------------------------------
Fax | 734-971-7585
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER / PRESIDENT
-----------------------------------------------------
Name | DR. THOMAS FOLEY KABISCH
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 734-971-5483
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | L998169
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------