Provider Demographics
NPI:1174583199
Name:POW, THOMAS K (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:K
Last Name:POW
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:3950 HOLLYWOOD RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-9159
Mailing Address - Country:US
Mailing Address - Phone:269-985-1000
Mailing Address - Fax:269-983-1627
Practice Address - Street 1:3950 HOLLYWOOD RD
Practice Address - Street 2:SUITE 110
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-9159
Practice Address - Country:US
Practice Address - Phone:269-985-1000
Practice Address - Fax:269-983-1627
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2019-04-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI430154928207RC0000X
MI4301054928207UN0901X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3444708Medicaid
MI0M95350OtherMEDICARE GROUP PIN
MIB87153Medicare UPIN
MI3444708Medicaid