Dr Martin Daniel Theriault, MD | |
17000 Kercheval Ave Ste 205, Grosse Pointe, MI 48230-1570 | |
(313) 640-2424 | |
Not Available |
Full Name | Dr Martin Daniel Theriault |
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Gender | Male |
Speciality | Family Medicine |
Location | 17000 Kercheval Ave Ste 205, Grosse Pointe, Michigan |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
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1689291270 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | 4301508399 (Michigan) | Primary |
Entity Name | Oakwood Ambulatory Llc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1003829441 PECOS PAC ID: 1850282914 Enrollment ID: O20040320000401 |
Mailing Address | Practice Location Address |
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Dr Martin Daniel Theriault, MD 26901 Beaumont Blvd Ste 3d, Southfield, MI 48033-3849 Ph: (947) 522-1922 | Dr Martin Daniel Theriault, MD 17000 Kercheval Ave Ste 205, Grosse Pointe, MI 48230-1570 Ph: (313) 640-2424 |
Daniel George Paglia, DO Family Medicine Medicare: Medicare Enrolled Practice Location: 468 Cadieux Rd, Grosse Pointe, MI 48230 Phone: 586-498-4422 | |
Sawsan Talib Edriss, MD Family Medicine Medicare: Medicare Enrolled Practice Location: 468 Cadieux Rd, Grosse Pointe, MI 48230 Phone: 586-498-4422 | |
Dr. Tarek Shokr, M.D. Family Medicine Medicare: Medicare Enrolled Practice Location: 468 Cadieux Rd, Grosse Pointe, MI 48230 Phone: 586-498-4422 Fax: 586-498-4440 | |
Trevor Ryan Evans, DO Family Medicine Medicare: Medicare Enrolled Practice Location: 468 Cadieux Rd, Grosse Pointe, MI 48230 Phone: 586-498-4400 | |
Michelle Stone, M.D. Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 16815 E Jefferson Ave Ste 120, Grosse Pointe, MI 48230 Phone: 586-498-4400 | |
Amar Patel, M.D. Family Medicine Medicare: Medicare Enrolled Practice Location: 468 Cadieux Rd, Grosse Pointe, MI 48230 Phone: 586-498-4422 Fax: 586-498-4440 | |
Dr. Kalid Farid Badran, MD Family Medicine Medicare: Medicare Enrolled Practice Location: 468 Cadieux Rd, Grosse Pointe, MI 48230 Phone: 586-498-4422 |