Organization Name: | DR. J. THWAINEY MD PC |
NPI Number: | 1962694661 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JALAL THWAINEY (OWNER) |
Mailing Address: | 7106 Park Ave Allen Park |
State: | MI US |
Postal Code: | 481012038 |
Phone Number: | 3133838310 |
Fax Number: | 3133832756 |
NPI Enumeration Date: | 08/16/2007 |
NPI Last Update Date: | 08/16/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 4301047446 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |