Provider Demographics
NPI:1962654699
Name:MOJUME, THOMAS ARINZE (RPT)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:ARINZE
Last Name:MOJUME
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 CHERRY OAK CT
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48186-3452
Mailing Address - Country:US
Mailing Address - Phone:313-408-9960
Mailing Address - Fax:734-729-5763
Practice Address - Street 1:155 CHERRY OAK CT
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48186-3452
Practice Address - Country:US
Practice Address - Phone:313-408-9960
Practice Address - Fax:734-729-5763
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-13
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501005270225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI650H226910OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MI650H226910OtherBLUE CROSS BLUE SHIELD OF MICHIGAN