Individual
DR. THOMAS PARK
Active
Individual
DR. THOMAS PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
040933
MI
2084P0800X
Psychiatry Physician
Primary
4301040933
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
M13298001
PTAN
MI
Enumeration date
09/27/2006
Last updated
08/16/2023
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