Provider Demographics
NPI:1861426348
Name:WATKINS, THOMAS LEE (DO)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:LEE
Last Name:WATKINS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:855 OAKRIDGE RD.
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49441-4023
Mailing Address - Country:US
Mailing Address - Phone:231-755-6038
Mailing Address - Fax:231-747-9645
Practice Address - Street 1:855 OAKRIDGE RD.
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441-4023
Practice Address - Country:US
Practice Address - Phone:231-755-6038
Practice Address - Fax:231-747-9645
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101010079207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1843599Medicaid