Provider Demographics
NPI:1952343352
Name:PINTAR, THOMAS J (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:PINTAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:45640 SCHOENHERR RD
Mailing Address - Street 2:STE B
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-6033
Mailing Address - Country:US
Mailing Address - Phone:586-247-4300
Mailing Address - Fax:586-532-6496
Practice Address - Street 1:5610 W GAGE ST
Practice Address - Street 2:SUITE A
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-1349
Practice Address - Country:US
Practice Address - Phone:208-501-8955
Practice Address - Fax:208-367-3332
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2022-09-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01052446207RN0300X
IDM116677207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200268380Medicaid
OH2173133Medicaid
INM400023138Medicare PIN
IN925060KKKMedicare PIN
OH2173133Medicaid
ID0H26358Medicare PIN