Provider Demographics
NPI:1336162122
Name:TOMSAK, ROBERT L (MD, PHD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:TOMSAK
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 E. MAPLE RD
Mailing Address - Street 2:SUITE 400-CREDENTIALING
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1189
Mailing Address - Country:US
Mailing Address - Phone:248-581-5976
Mailing Address - Fax:248-581-5640
Practice Address - Street 1:4717 ST ANTOINE
Practice Address - Street 2:KRESGE EYE INSTITUTE
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-1423
Practice Address - Country:US
Practice Address - Phone:313-577-8900
Practice Address - Fax:313-577-0700
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-043259207W00000X
MI4301095698207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH738110OtherBUCKEYE MEDICAID
OH2386992OtherAETNA
130023873OtherMCR RR
OHP00398391OtherRAILROAD MEDICARE
OH0445718Medicaid
OH000000510698OtherANTHEM
OH000000221074OtherUNISON
OH364082OtherWELLCARE MEDICAID
OHTO0481088Medicare PIN
OH2386992OtherAETNA
MI0P30630648Medicare PIN
OH000000221074OtherUNISON
OH738110OtherBUCKEYE MEDICAID