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General NPI Number Information
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NPI Number | 1710230511
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Entity Type | Organization
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Legal Business Name | ADVANCED PHYSICIAN CARE ORGANIZATION PLLC
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Dates
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Enumeration Date | 10/18/2012
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Last Update Date | 03/13/2013
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Provider Practice Location Address
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Address Line | 43455 SCHOENHERR RD SUITE 17
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City | STERLING HEIGHTS
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State | MI
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Zip | 48313-1951
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Country | US
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Telephone | 586-726-4823
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Fax |
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Provider Business Mailing Address
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Address Line | 1701 SOUTH BLVD E SUITE 240
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City | ROCHESTER HILLS
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State | MI
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Zip | 48307-6122
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Country | US
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Telephone | 248-997-7000
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THEODORE TANGALOS
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Credential | MD
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Telephone | 586-726-4823
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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