Provider Demographics
NPI:1144604943
Name:MCCONNELL, THOMAS (NP)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:
Last Name:MCCONNELL
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 GOLDEN LN
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-3657
Mailing Address - Country:US
Mailing Address - Phone:734-482-8238
Mailing Address - Fax:
Practice Address - Street 1:2025 FORD AVE STE 100
Practice Address - Street 2:
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192-2301
Practice Address - Country:US
Practice Address - Phone:734-281-3080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704264062363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care