MEDICARE: DR. RAAD TOMA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	4301052904	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	700F314390	OTHER	MI	BLUE SHIELD

General Provider Information

NPI Number	:	1447235015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAAD TOMA M.D.

Provider Business Mailing Address
First Line	:	15300 W 9 MILE RD STE 1
Second Line	:
City	:	OAK PARK
State	:	MI
Zip	:	48237-2585
Country	:	US
Telephone Number	:	248-968-2003
Fax Number	:	248-967-2276

Provider Business Practice Location Address
First Line	:	39150 DEQUINDRE RD STE 200
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-6983
Country	:	US
Telephone Number	:	586-268-5440
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/07/2005
Last Update Date	:	03/21/2020

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