Individual
THOMAS K CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2525 5TH AVE S, ESCANABA, MI 49829-1204
(906) 786-6047
(906) 786-0660
Mailing address
2525 5TH AVE S, ESCANABA, MI 49829-1204
(906) 786-6047
(906) 786-0660
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
4301068161
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0402100422
BLUE CROSS BLUE SHIELD OF MICHIGAN
MI
05
—
3257840
—
MI
05
—
4198743
—
MI
01
—
CG4010
RAILROAD GROUP
—
Enumeration date
05/01/2006
Last updated
12/27/2011
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