Provider Demographics
NPI:1770604928
Name:THABOLINGAM, PREETI (MD)
Entity type:Individual
Prefix:MRS
First Name:PREETI
Middle Name:
Last Name:THABOLINGAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PREETI
Other - Middle Name:
Other - Last Name:KALIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:43750 WOODWARD STE 104
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-5063
Mailing Address - Country:US
Mailing Address - Phone:248-334-6000
Mailing Address - Fax:248-334-8740
Practice Address - Street 1:43750 WOODWARD STE 104
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-5063
Practice Address - Country:US
Practice Address - Phone:248-334-6000
Practice Address - Fax:248-334-8740
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL336078398208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics