Provider Demographics
NPI:1558364562
Name:THORREZ, DAVID C (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:C
Last Name:THORREZ
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 1:2900 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:STE 1
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-2061
Practice Address - Country:US
Practice Address - Phone:734-572-8686
Practice Address - Fax:734-572-8866
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301035414208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1703293Medicaid
MIF03694Medicare UPIN