Provider Demographics
NPI:1891773172
Name:TOMC, MICHAEL W (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:W
Last Name:TOMC
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:75 HOSPITAL DR
Mailing Address - Street 2:SUITE 350
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-2857
Mailing Address - Country:US
Mailing Address - Phone:740-594-4476
Mailing Address - Fax:740-594-4227
Practice Address - Street 1:75 HOSPITAL DR
Practice Address - Street 2:SUITE 350
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-2857
Practice Address - Country:US
Practice Address - Phone:740-594-4476
Practice Address - Fax:740-594-4227
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH34003418T207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000008746OtherANTHEM/ BCBS
OH0600175Medicaid
OHTO572084Medicare ID - Type Unspecified
OH0600175Medicaid