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NPI Code Detail

MEDICARE: DR. THOMAS J DITKOFF MD

MEDICARE: DR. THOMAS J DITKOFF MD
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
1207X00000XOrthopaedic Surgery Physician4301030676MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
20F31114OTHERMIBCBS
30767220001OTHERMIADMINISTAR FEDERAL
40F33583OTHERMIBCBS DME

General Provider Information

NPI Number : 1497736771
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. THOMAS J DITKOFF MD
Provider Business Mailing Address
First Line : 26025 LAHSER RD
Second Line : 2ND FLOOR
City : SOUTHFIELD
State : MI
Zip : 48033-2601
Country : US
Telephone Number : 248-663-1900
Fax Number : 248-663-1902
Provider Business Practice Location Address
First Line : 26025 LAHSER RD
Second Line : 2ND FLOOR
City : SOUTHFIELD
State : MI
Zip : 48033-2601
Country : US
Telephone Number : 248-663-1900
Fax Number : 248-663-1902
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/14/2005
Last Update Date : 01/12/2010

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Directions to “ DR. THOMAS J DITKOFF MD” Practice Location

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