Provider Demographics
NPI:1992899389
Name:RILEY, THOMAS H (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:H
Last Name:RILEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:5900 BYRON CENTER AVE SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519-9686
Mailing Address - Country:US
Mailing Address - Phone:616-252-3243
Mailing Address - Fax:616-252-6256
Practice Address - Street 1:METRO HEALTH - UNIVERSITY OF MICHIGAN HEALTH
Practice Address - Street 2:2093 HEALTH DRIVE SW
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519
Practice Address - Country:US
Practice Address - Phone:505-462-6200
Practice Address - Fax:505-462-6218
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMMD2004-0777207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM76883353Medicaid
G02010Medicare UPIN
NM76883353Medicaid