Provider Demographics
NPI:1861496747
Name:HALL, THOMAS M (DPM)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:M
Last Name:HALL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 N MAIN ST STE 240
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118-1370
Mailing Address - Country:US
Mailing Address - Phone:734-433-5800
Mailing Address - Fax:734-433-5801
Practice Address - Street 1:350 N MAIN ST STE 240
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118-1370
Practice Address - Country:US
Practice Address - Phone:734-433-5800
Practice Address - Fax:734-433-5801
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001833213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI480H219870OtherBLUE CARE NETWORK
MA125159OtherCARE CHOICES
MI5656449OtherAETNA
MI480029417OtherRAILROAD MEDICARE
MIT87674OtherHAP
MI4858251900OtherBCBS
MIQMXPR0014193OtherMOLINA
MI3313528Medicaid
MI5825190OtherBCN
MI1500133OtherCIGNA
MIT87674Medicare UPIN
MI0612730001Medicare NSC
MI480H219870OtherBLUE CARE NETWORK
MI3313528Medicaid