Individual
DR. THOMAS JOHN ARCHAMBEAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3264 N EVERGREEN DR NE, GRAND RAPIDS, MI 49525-9746
(616) 363-7339
(616) 361-5828
Mailing address
3264 N EVERGREEN DR NE, GRAND RAPIDS, MI 49525-9746
(616) 363-7339
(616) 361-5828
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
4301045566
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1691094
—
MI
05
—
1691138
—
MI
01
—
200000001150
PHP OF MIDMICHIGAN
MI
05
—
2726185
—
MI
01
—
300023165
RAILROAD MEDICARE
MI
01
—
300023183
RAILROAD MEDICARE
MI
Enumeration date
10/23/2006
Last updated
08/04/2009
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