Provider Demographics
NPI:1962450437
Name:ALDERSON, THOMAS L (DO)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:L
Last Name:ALDERSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 S BALLENGER HWY
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3638
Mailing Address - Country:US
Mailing Address - Phone:810-342-1000
Mailing Address - Fax:810-342-1590
Practice Address - Street 1:36500 S GRATIOT AVE
Practice Address - Street 2:STE. 202
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48035-1772
Practice Address - Country:US
Practice Address - Phone:586-493-3740
Practice Address - Fax:586-493-3720
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101012950207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4178105Medicaid
MI4984868Medicaid
MI4178339Medicaid
MI4178339Medicaid
MI4984868Medicaid
MIM95100004Medicare ID - Type Unspecified