Provider Demographics
NPI:1528597713
Name:PAUGH, THERON
Entity Type:Individual
Prefix:
First Name:THERON
Middle Name:
Last Name:PAUGH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31330 SCHOOLCRAFT RD STE 200
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-2042
Mailing Address - Country:US
Mailing Address - Phone:734-525-9712
Mailing Address - Fax:
Practice Address - Street 1:31330 SCHOOLCRAFT RD STE 200
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-2042
Practice Address - Country:US
Practice Address - Phone:734-525-9712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionist