Individual
DR. THOMAS MICHAEL WITHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
200 JEFFERSON AVE SE, GRAND RAPIDS, MI 49503-4502
(616) 942-9610
Mailing address
PO BOX Q, GRAND RAPIDS, MI 49501-4917
(800) 968-6866
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
4301084261
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5218377
—
MI
01
—
P00434448
RAILROAD MEDICARE
—
01
—
TW084261
BLUE CROSS BLUE SHIELD
MI
Enumeration date
04/24/2007
Last updated
03/04/2008
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