Provider Demographics
NPI:1346424447
Name:THORREZ MEDICAL PRACTICE PLC
Entity Type:Organization
Organization Name:THORREZ MEDICAL PRACTICE PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCCARREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-572-8686
Mailing Address - Street 1:2900 PACKARD RD STE 1
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-2061
Mailing Address - Country:US
Mailing Address - Phone:734-572-8686
Mailing Address - Fax:734-572-8866
Practice Address - Street 1:2900 PACKARD RD
Practice Address - Street 2:SUITE 1
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-2060
Practice Address - Country:US
Practice Address - Phone:734-572-8686
Practice Address - Fax:734-572-8866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-26
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301035414208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0H11972OtherBCBSM
MI350H115430OtherBLUE CROSS BLUE SHIELD