Healthcare Provider Details

I. General information

NPI: 1629164397
Provider Name (Legal Business Name): THERESA M ONEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 02/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20870 MACK AVENUE
GROSSE POINTE MI
48236
US

IV. Provider business mailing address

20870 MACK AVENUE
GROSSE POINTE MI
48236
US

V. Phone/Fax

Practice location:
  • Phone: 313-885-2334
  • Fax:
Mailing address:
  • Phone: 313-885-2334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number49343
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number4301085683
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: