Provider Demographics
NPI:1104820463
Name:ANAN, THOMAS JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:JOSEPH
Last Name:ANAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25691 STRATH HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-2342
Mailing Address - Country:US
Mailing Address - Phone:586-256-4170
Mailing Address - Fax:248-465-4901
Practice Address - Street 1:25691 STRATH HAVEN DR
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-2342
Practice Address - Country:US
Practice Address - Phone:586-256-4170
Practice Address - Fax:248-465-4901
Is Sole Proprietor?:No
Enumeration Date:2005-06-02
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301050032207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI264245010Medicaid
MIF22543Medicare UPIN
MI264245010Medicaid