Provider Demographics
NPI:1003040288
Name:RAVEEND THABOLINGAM MD PC
Entity Type:Organization
Organization Name:RAVEEND THABOLINGAM MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RAVEEND
Authorized Official - Middle Name:
Authorized Official - Last Name:THABOINGAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-552-1200
Mailing Address - Street 1:18161 W 12 MILE RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LATHRUP VILLAGE
Mailing Address - State:MI
Mailing Address - Zip Code:48076-2662
Mailing Address - Country:US
Mailing Address - Phone:248-552-1200
Mailing Address - Fax:248-552-1201
Practice Address - Street 1:18161 W 12 MILE RD
Practice Address - Street 2:SUITE 2
Practice Address - City:LATHRUP VILLAGE
Practice Address - State:MI
Practice Address - Zip Code:48076-2662
Practice Address - Country:US
Practice Address - Phone:248-552-1200
Practice Address - Fax:248-552-1201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-04
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRT080781207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOP38160008Medicare PIN