Provider Demographics
NPI:1215990254
Name:KEHN, THOMAS E (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:E
Last Name:KEHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5477 W CLARK RD
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1102
Mailing Address - Country:US
Mailing Address - Phone:734-434-6000
Mailing Address - Fax:734-434-7005
Practice Address - Street 1:5477 W CLARK RD
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1102
Practice Address - Country:US
Practice Address - Phone:734-434-6000
Practice Address - Fax:734-434-7005
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301057866207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4130667Medicaid
MIOH16033-010Medicare ID - Type Unspecified
MI4130667Medicaid