Provider Demographics
NPI:1518044585
Name:OSINOWO, THOMAS O (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:O
Last Name:OSINOWO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SEAGATE # 800
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1558
Mailing Address - Country:US
Mailing Address - Phone:734-240-1760
Mailing Address - Fax:734-240-1763
Practice Address - Street 1:730 N MONROE ST # 200
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-2972
Practice Address - Country:US
Practice Address - Phone:734-240-1760
Practice Address - Fax:734-240-1763
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0825282084F0202X
MI43011165252084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH67349Medicare UPIN