Provider Demographics
NPI:1548600638
Name:TD OWEIS MD PLC
Entity Type:Organization
Organization Name:TD OWEIS MD PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ACUTE CARE TRAUMA SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:OWEIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-450-3768
Mailing Address - Street 1:1528 LAWNDALE DR
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-1158
Mailing Address - Country:US
Mailing Address - Phone:419-450-3768
Mailing Address - Fax:
Practice Address - Street 1:1528 LAWNDALE DR
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-1158
Practice Address - Country:US
Practice Address - Phone:419-450-3768
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-03
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010592832086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI69830Medicare PIN