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General NPI Number Information
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NPI Number | 1477996502
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Entity Type | Individual
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Provider Name | THERESE MARIA SASSALOS M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/08/2013
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Last Update Date | 08/18/2025
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Provider Practice Location Address
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Address Line | HENRY FORD HOSPITAL 2799 W GRAND BLVD CFP 363
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City | DETROIT
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State | MI
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Zip | 48202
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Country | US
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Telephone | 313-916-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 6777 W MAPLE RD
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322-3013
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Country | US
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Telephone | 248-325-1091
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 4301102935
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License Number State | MI
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