Provider Demographics
NPI:1306899935
Name:HILTS, THOMAS (DO)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:HILTS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 STATE ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-4328
Mailing Address - Country:US
Mailing Address - Phone:616-685-1808
Mailing Address - Fax:616-685-1850
Practice Address - Street 1:1471 E BELTLINE AVE NE
Practice Address - Street 2:SUITE 201
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-4548
Practice Address - Country:US
Practice Address - Phone:616-616-6858
Practice Address - Fax:616-447-7674
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101012022207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4313380Medicaid
MI4313371Medicaid
MI4877133Medicaid
MI4313344Medicaid
MI4313522Medicaid
MI4591646Medicaid
MI4313531Medicaid
MI4313513Medicaid
MIM69390167Medicare ID - Type Unspecified
MI4591646Medicaid
MIM02830103Medicare ID - Type Unspecified
MIP32930081Medicare ID - Type Unspecified