Provider Demographics
NPI:1659559110
Name:TECUMSEH FAMILY PRACTICE P.C.
Entity Type:Organization
Organization Name:TECUMSEH FAMILY PRACTICE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:DOMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:517-423-2960
Mailing Address - Street 1:501 E CUMMINS ST
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:MI
Mailing Address - Zip Code:49286-2070
Mailing Address - Country:US
Mailing Address - Phone:517-423-2960
Mailing Address - Fax:517-423-2786
Practice Address - Street 1:501 E CUMMINS ST
Practice Address - Street 2:
Practice Address - City:TECUMSEH
Practice Address - State:MI
Practice Address - Zip Code:49286-2070
Practice Address - Country:US
Practice Address - Phone:517-423-2960
Practice Address - Fax:517-423-2786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2010-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI008869207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700D61016OtherBCBS OF MICHIGAN