Basic Information
| Provider Information | |||||||||
| NPI: | 1003040288 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RAVEEND THABOLINGAM MD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18161 W 12 MILE RD | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | LATHRUP VILLAGE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480762662 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2485521200 | ||||||||
| FaxNumber: | 2485521201 | ||||||||
| Practice Location | |||||||||
| Address1: | 18161 W 12 MILE RD | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | LATHRUP VILLAGE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480762662 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2485521200 | ||||||||
| FaxNumber: | 2485521201 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2009 | ||||||||
| LastUpdateDate: | 05/04/2009 | ||||||||
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| AuthorizedOfficialLastName: | THABOINGAM | ||||||||
| AuthorizedOfficialFirstName: | RAVEEND | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 2485521200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | RT080781 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.