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NPI Code Detail

MEDICARE: THERESA ESTIPHAN MD

MEDICARE:   THERESA  ESTIPHAN  MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084N0402XNeurology with Special Qualifications in Child Neurology Physician4301506188MI

General Provider Information

NPI Number : 1871957118
Entity Type Code : Individual
Provider Name (Legal Business Name) : THERESA ESTIPHAN MD
Provider Business Mailing Address
First Line : 3621 S STATE ST
Second Line :
City : ANN ARBOR
State : MI
Zip : 48108-1633
Country : US
Telephone Number : 734-647-5299
Fax Number :
Provider Business Practice Location Address
First Line : 1500 E MEDICAL CTR DR
Second Line :
City : ANN ARBOR
State : MI
Zip : 48109-5000
Country : US
Telephone Number : 734-936-5000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/13/2016
Last Update Date : 05/05/2026

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Directions to “ THERESA ESTIPHAN MD” Practice Location

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