Provider Demographics
NPI:1124094057
Name:NEIDLINGER, THOMAS (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:NEIDLINGER
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 1:215 E MANSION ST
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:MARSHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49068-1559
Mailing Address - Country:US
Mailing Address - Phone:269-781-1122
Mailing Address - Fax:269-781-5933
Practice Address - Street 1:215 E MANSION ST
Practice Address - Street 2:SUITE 2A
Practice Address - City:MARSHALL
Practice Address - State:MI
Practice Address - Zip Code:49068-1559
Practice Address - Country:US
Practice Address - Phone:269-781-1122
Practice Address - Fax:269-781-5933
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITN036652207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI101633260Medicaid
MI16334OtherHEALTH PLAN OF MICHIGAN
MI0131148OtherBCBSM
MIB44515Medicare UPIN
MI16334OtherHEALTH PLAN OF MICHIGAN