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Organization
TBCI PC
Active
Organization
TBCI PC
Active
Other names
Traumatic Brain and Catastrophic Injury PC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS J PARK MD (MEDICAL DIRECTOR)
(248) 526-0110
Entity
Organization
Contact information
Practice address
1059 OWENDALE, TROY, MI 48083
(248) 526-0110
(248) 680-9138
Mailing address
1059 OWENDALE, TROY, MI 48083
(248) 526-0110
(248) 680-9138
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
2084P0800X
Psychiatry Physician
—
—
225100000X
Physical Therapist
—
—
225400000X
Rehabilitation Practitioner
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30421
BLUE CROSS
MI
Enumeration date
11/13/2006
Last updated
09/11/2025
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