Provider Demographics
NPI:1982653242
Name:LAMMY, THOMAS G (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:G
Last Name:LAMMY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 397
Mailing Address - Street 2:
Mailing Address - City:SUTTONS BAY
Mailing Address - State:MI
Mailing Address - Zip Code:49682-0397
Mailing Address - Country:US
Mailing Address - Phone:231-271-5990
Mailing Address - Fax:231-271-5959
Practice Address - Street 1:93 W 4TH ST STE C
Practice Address - Street 2:
Practice Address - City:SUTTONS BAY
Practice Address - State:MI
Practice Address - Zip Code:49682-8408
Practice Address - Country:US
Practice Address - Phone:231-271-5990
Practice Address - Fax:231-271-5959
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITL047970207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4254806Medicaid
MI1982653242Medicaid
MI700D510020OtherBCBS
MI700D510020OtherBLUE CARE NETWORK
MI700D510020OtherBCBS
MIB45989Medicare UPIN