Tri County MD PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

TD062122 Issued in MI

Legal business name

TRI COUNTY MD PC

Practice address

624 E 9 Mile Rd
Hazel Park, MI 48030-1842

Phone

(248) 541-1114

NPI assigned

Mar 22, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Thulasi Divi, MD

Title

Owner

Phone

(248) 541-1114

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1332374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332374400000",
    "number": "1992071070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "624 E 9 MILE RD",
            "city": "HAZEL PARK",
            "state": "MI",
            "postal_code": "480301842",
            "telephone_number": "248-541-1114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "624 E 9 MILE RD",
            "city": "HAZEL PARK",
            "state": "MI",
            "postal_code": "480301842",
            "telephone_number": "248-541-1114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI COUNTY MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-22",
        "last_updated": "2012-03-22",
        "status": "A",
        "authorized_official_last_name": "DIVI",
        "authorized_official_first_name": "THULASI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "248-541-1114",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "TD062122",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.