Provider Demographics
NPI:1407060874
Name:TLC MICHIGAN, LLC
Entity Type:Organization
Organization Name:TLC MICHIGAN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-761-2235
Mailing Address - Street 1:2723 S STATE ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-6188
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:34405 W 12 MILE RD
Practice Address - Street 2:SUITE 154
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-3391
Practice Address - Country:US
Practice Address - Phone:248-489-0400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty