Provider Demographics
NPI:1114668241
Name:MORTON, THAYER JOHN
Entity Type:Individual
Prefix:
First Name:THAYER
Middle Name:JOHN
Last Name:MORTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2799 WEST GRAND BLVD
Mailing Address - Street 2:CFP-258
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202
Mailing Address - Country:US
Mailing Address - Phone:313-916-1553
Mailing Address - Fax:313-916-7437
Practice Address - Street 1:2799 WEST GRAND BLVD
Practice Address - Street 2:CFP-258
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202
Practice Address - Country:US
Practice Address - Phone:313-916-1553
Practice Address - Fax:313-916-7437
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program