Provider Demographics
NPI:1215020813
Name:MILES, TOM R (DO)
Entity Type:Individual
Prefix:DR
First Name:TOM
Middle Name:R
Last Name:MILES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:500 MAIN STREET
Mailing Address - Street 2:SCHOOLCRAFT MEMORIAL HOSPITAL
Mailing Address - City:MANISTIQUE
Mailing Address - State:MI
Mailing Address - Zip Code:49854
Mailing Address - Country:US
Mailing Address - Phone:906-341-3257
Mailing Address - Fax:906-341-3255
Practice Address - Street 1:500 MAIN STREET
Practice Address - Street 2:SCHOOLCRAFT MEMORIAL HOSPITAL
Practice Address - City:MANISTIQUE
Practice Address - State:MI
Practice Address - Zip Code:49854
Practice Address - Country:US
Practice Address - Phone:906-341-3257
Practice Address - Fax:906-341-3255
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010061942085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIE31598Medicare UPIN
MIG76001022Medicare ID - Type Unspecified