Provider Demographics
NPI:1578586780
Name:KING, THOMAS IGNATIUS (DPM)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:IGNATIUS
Last Name:KING
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1431 E 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-2653
Mailing Address - Country:US
Mailing Address - Phone:248-542-5372
Mailing Address - Fax:248-398-4345
Practice Address - Street 1:1431 E 12 MILE RD
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-2653
Practice Address - Country:US
Practice Address - Phone:248-542-5372
Practice Address - Fax:248-398-4345
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITK001638213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3361070Medicaid
MI3361070Medicaid
U50767Medicare UPIN