Individual
DR. KEITH B TOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
49221 VAN DYKE, SHELBY TWP, MI 48317-1336
(586) 254-4860
(586) 254-5844
Mailing address
49221 VAN DYKE, SHELBY TWP, MI 48317-1336
(586) 254-4860
(586) 254-5844
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5101008999
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2646558
—
MI
Enumeration date
11/29/2005
Last updated
10/25/2007
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