Individual
THOMAS W GORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 MICHIGAN ST NE, GRAND RAPIDS, MI 49503-2560
(616) 975-1845
(616) 285-0846
Mailing address
2537 MOMENTUM PL, CHICAGO, IL 60689-5325
(616) 988-8220
(616) 285-0846
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
4301099948
MI
207Q00000X
Family Medicine Physician
MD027389E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0670028
BCBSM PIN
MI
Enumeration date
06/29/2006
Last updated
11/04/2013
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