Individual
MR. THOMAS HARRISON BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1121 E MCNICHOLS RD, DETROIT, MI 48203-2857
(313) 365-3113
Mailing address
8290 E 10 MILE RD # A-15, CENTER LINE, MI 48015-1412
(586) 823-1465
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
08/06/2018
Last updated
08/06/2018
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