Provider Demographics
NPI:1710230511
Name:ADVANCED PHYSICIAN CARE ORGANIZATION PLLC
Entity Type:Organization
Organization Name:ADVANCED PHYSICIAN CARE ORGANIZATION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:
Authorized Official - Last Name:TANGALOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-726-4823
Mailing Address - Street 1:1701 SOUTH BLVD E
Mailing Address - Street 2:SUITE 240
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-6122
Mailing Address - Country:US
Mailing Address - Phone:248-997-7000
Mailing Address - Fax:
Practice Address - Street 1:43455 SCHOENHERR RD
Practice Address - Street 2:SUITE 17
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48313-1951
Practice Address - Country:US
Practice Address - Phone:586-726-4823
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-18
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty