Provider Demographics
NPI:1780859892
Name:MICHAEL H THEODOULOU
Entity Type:Organization
Organization Name:MICHAEL H THEODOULOU
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:H
Authorized Official - Last Name:THEODOULOU
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:202-237-0038
Mailing Address - Street 1:3301 NEW MEXICO AVE NW
Mailing Address - Street 2:STE 221
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-3622
Mailing Address - Country:US
Mailing Address - Phone:202-237-0038
Mailing Address - Fax:202-237-2551
Practice Address - Street 1:3301 NEW MEXICO AVE NW
Practice Address - Street 2:STE 221
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-3622
Practice Address - Country:US
Practice Address - Phone:202-237-0038
Practice Address - Fax:202-237-2551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCP0558335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD020331900Medicaid
DC607382Medicare PIN
MD020331900Medicaid
DC0481710001Medicare NSC