Healthcare Provider Details

I. General information

NPI: 1639473325
Provider Name (Legal Business Name): MACOMB PROMPT CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2011
Last Update Date: 01/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15959 HALL RD SUITE 104
MACOMB MI
48044-5363
US

IV. Provider business mailing address

43455 SCHOENHERR ROAD SUITE 2
STERLING HEIGHTS MI
48044-1972
US

V. Phone/Fax

Practice location:
  • Phone: 586-884-2688
  • Fax: 586-566-1674
Mailing address:
  • Phone: 586-726-8423
  • Fax: 586-726-8365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. THEODORE L TANGALOS
Title or Position: OWNER
Credential: M.D.
Phone: 586-726-4823