Individual
THOMAS K MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2001 COOLIDGE RD, EAST LANSING, MI 48823-1378
(517) 337-1668
(517) 337-1779
Mailing address
2001 COOLIDGE RD, EAST LANSING, MI 48823-1378
(517) 337-1668
(517) 337-1779
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
4301047643
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1614148
—
MI
01
—
180011842
RAILROAD MEDICARE
MI
01
—
200000002424
PHPMM
MI
01
—
TM047643
STATE LICENSE NUMBER
MI
Enumeration date
12/09/2005
Last updated
09/03/2008
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