Provider Demographics
NPI:1184673709
Name:OO, THAN N (MD)
Entity Type:Individual
Prefix:
First Name:THAN
Middle Name:N
Last Name:OO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:521 E MICHIGAN AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-3889
Mailing Address - Country:US
Mailing Address - Phone:269-349-6759
Mailing Address - Fax:269-349-7450
Practice Address - Street 1:521 E MICHIGAN AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-3889
Practice Address - Country:US
Practice Address - Phone:269-349-6759
Practice Address - Fax:269-349-7450
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2023-11-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301067357207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104481555Medicaid
MI1103901030OtherBCBS INDIVIDUAL
MI104871612Medicaid
MI104481555Medicaid
MI0M71430009Medicare PIN