Individual
THOMAS L POULIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 NAVARRE PL STE 5500, SOUTH BEND, IN 46601-1172
(574) 647-5200
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610
(574) 237-6069
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
01023972A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100222350
—
IN
Enumeration date
12/29/2005
Last updated
03/31/2021
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