Provider Demographics
NPI:1083698799
Name:OWEIS, THOMAS DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:DANIEL
Last Name:OWEIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1528 LAWNDALE DR
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-1158
Mailing Address - Country:US
Mailing Address - Phone:419-450-3768
Mailing Address - Fax:248-850-7727
Practice Address - Street 1:36475 5 MILE RD
Practice Address - Street 2:ATTN: TRAUMA SERVICES
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-1971
Practice Address - Country:US
Practice Address - Phone:734-655-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2024-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35072469208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2051407Medicaid
MIMI6983001Medicare PIN
OHG62281Medicare UPIN
OHOW0839351Medicare ID - Type Unspecified