Provider Demographics
NPI:1518939115
Name:DUNNE, THOMAS C (MD)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:C
Last Name:DUNNE
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 1:291 W CENTRE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-5353
Mailing Address - Country:US
Mailing Address - Phone:269-488-8430
Mailing Address - Fax:269-488-8551
Practice Address - Street 1:291 W CENTRE AVE
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-5353
Practice Address - Country:US
Practice Address - Phone:269-488-8430
Practice Address - Fax:269-488-8551
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301 0519492084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI158939115Medicaid
MIB46402Medicare UPIN
MI0C97625103Medicare PIN