Daniel, Theodore A

Daniel, Theodore A is an individual health care provider with primary practice located at 20225 E 9 Mile Rd Suite A, Saint Clair Shores MI 48080-1775. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as his primary health care specialty. Daniel, Theodore A can be contacted via phone (586) 772-1090.

Contact Information

Primary practice address
20225 E 9 Mile Rd Suite A Saint Clair Shores MI 48080-1775
Phone: (586) 772-1090
Fax: (586) 772-4366
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 4301047561 Michigan

Profile Details

NPI number 1689641615
LBN Legal business name Daniel, Theodore A
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 8th, 2006
Last updated Apr 7th, 2014 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1689641615 NPPES
Michigan MEDICAID 4373576

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