Provider Demographics
NPI:1225078108
Name:ROE, THOMAS F (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:F
Last Name:ROE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 E GRAND RIVER RD
Mailing Address - Street 2:
Mailing Address - City:LAINGSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:48848-8742
Mailing Address - Country:US
Mailing Address - Phone:517-651-2801
Mailing Address - Fax:517-651-2310
Practice Address - Street 1:317 E GRAND RIVER RD
Practice Address - Street 2:
Practice Address - City:LAINGSBURG
Practice Address - State:MI
Practice Address - Zip Code:48848-8742
Practice Address - Country:US
Practice Address - Phone:517-651-2801
Practice Address - Fax:517-651-2310
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301043894207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1225078108Medicaid
MIN53550093Medicare PIN