Individual
DR. MICHAEL THOMAS PRUDHOMME
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.T.
Contact information
Practice address
13638 SIBLEY RD, RIVERVIEW, MI 48193-7406
(734) 288-3739
(734) 288-3745
Mailing address
13638 SIBLEY RD, RIVERVIEW, MI 48193-7406
(734) 288-3739
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
5501010391
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OH28738
BCBSM PIN
MI
Enumeration date
01/10/2011
Last updated
08/28/2014
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