Healthcare Provider Details

I. General information

NPI: 1851529614
Provider Name (Legal Business Name): TINA MARIA METROPOULOS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2009
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4290 COPPER RIDGE DR STE 200
TRAVERSE CITY MI
49684-7205
US

IV. Provider business mailing address

4290 COPPER RIDGE DR STE 200
TRAVERSE CITY MI
49684-7205
US

V. Phone/Fax

Practice location:
  • Phone: 231-935-8930
  • Fax: 231-935-8811
Mailing address:
  • Phone: 231-935-8930
  • Fax: 231-935-8811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number5101018149
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101018149
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: