MEDICARE: THOMAS I KING DPM PC

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	213E00000X	Podiatrist	TK001638	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

General Provider Information

NPI Number	:	1710126156
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THOMAS I KING DPM PC

Provider Business Mailing Address
First Line	:	1431 EAST TWELVE MILE RD
Second Line	:	BUILLDING C
City	:	MADISON HEIGHTS
State	:	MI
Zip	:	48071
Country	:	US
Telephone Number	:	248-542-5374
Fax Number	:	248-398-4345

Provider Business Practice Location Address
First Line	:	1431 EAST TWELVE MILE RD
Second Line	:	BUILLDING C
City	:	MADISON HEIGHTS
State	:	MI
Zip	:	48071
Country	:	US
Telephone Number	:	248-542-5374
Fax Number	:	248-398-4345

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	THOMAS I KING
Credential	:	DPM
Telephone Number	:	248-542-7354

Provider Enumeration Date	:	02/09/2009
Last Update Date	:	03/04/2009

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