Healthcare Provider Details

I. General information

NPI: 1033460332
Provider Name (Legal Business Name): ADVANCED PHYSICIAN CARE ORGANIZATION PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2012
Last Update Date: 10/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43455 SCHOENHERR RD SUITE 17
STERLING HEIGHTS MI
48313-1951
US

IV. Provider business mailing address

43455 SCHOENHERR RD SUITE 17
STERLING HEIGHTS MI
48313-1951
US

V. Phone/Fax

Practice location:
  • Phone: 586-726-4823
  • Fax: 586-726-8365
Mailing address:
  • Phone: 586-726-4823
  • Fax: 586-726-8365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

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