Organization
THOMAS KNUTH MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KATHY A VIVIANO (MANAGER)
(585) 552-5333
Entity
Organization
Contact information
Practice address
22101 MOROSS RD, PROF BLD 1 SUITE 332, DETROIT, MI 48236-2148
(586) 552-5333
(586) 552-5326
Mailing address
PO BOX 806403, SAINT CLAIR SHORES, MI 48080-6403
(586) 552-5333
(586) 552-5326
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
4301089707
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0H28467
BCBS MICHIGAN
MI
Enumeration date
11/25/2013
Last updated
01/03/2014
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