Theodoulou, Michael Hercules

Theodoulou, Michael Hercules is an individual health care provider with primary practice located at 230 Highland Ave , Somerville MA 02143-1408. He recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Podiatrist, which is considered as his primary health care specialty. Theodoulou, Michael Hercules can be contacted via phone (617) 665-1000.

Contact Information

Primary practice address
230 Highland Ave Somerville MA 02143-1408
Phone: (617) 665-1000
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Podiatrist 213E00000X PO558 District of Columbia
Podiatric Medicine & Surgery Service Providers / Podiatrist 213E00000X 01073 Maryland
Podiatric Medicine & Surgery Service Providers / Podiatrist 213E00000X 2358 Massachusetts

Profile Details

NPI number 1760430755
LBN Legal business name Theodoulou, Michael Hercules
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 No
Enumeration date May 4th, 2006
Last updated Dec 8th, 2011 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1760430755 NPPES
Massachusetts MEDICAID 110084502A

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