Provider Demographics
NPI:1053317479
Name:HOSEY, THOMAS CARL (DPM)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:CARL
Last Name:HOSEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:42550 GARFIELD RD
Mailing Address - Street 2:STE 103
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1644
Mailing Address - Country:US
Mailing Address - Phone:586-263-4411
Mailing Address - Fax:586-286-1142
Practice Address - Street 1:42550 GARFIELD RD
Practice Address - Street 2:STE 103
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-1644
Practice Address - Country:US
Practice Address - Phone:586-263-4411
Practice Address - Fax:586-286-1142
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001045213EP1101X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI103915OtherGREATLAKES
MIDB8851OtherRAILROAD GROUP
MI5110230001OtherADMINASTAR FEDERAL DME
MI55010950OtherBLUECROSS BLUESHIELD IND
MI135073500OtherWORKER COMP
MI4618703OtherMOLINA
MIP00134504OtherRAILROAD INDIVIDUAL
MIT34046OtherHEALTH ALLIANCE PLAN
MI4618703OtherWELLNESS
MI200826048OtherOMNICARE
MI4073108OtherAETNA
MIC2566OtherMCARE
MI102168OtherCARE CHOICES
MI009651OtherMIDWEST HEALTH PLAN
MI134618703Medicaid
MI480E015590OtherBLUE CROSS BLUE SHIELD GP
MI4618703OtherWELLNESS
MIDB8851OtherRAILROAD GROUP