Provider Demographics
NPI:1578951943
Name:DUNN, THOMAS (BOCO)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:
Last Name:DUNN
Suffix:
Gender:M
Credentials:BOCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 N WALNUT ST
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48933-1124
Mailing Address - Country:US
Mailing Address - Phone:517-316-0802
Mailing Address - Fax:517-316-0804
Practice Address - Street 1:314 N WALNUT ST
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48933-1124
Practice Address - Country:US
Practice Address - Phone:517-316-0802
Practice Address - Fax:517-316-0804
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-07
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC50210222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist