Individual
DR. MICHAEL HERCULES THEODOULOU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
230 HIGHLAND AVE, SOMERVILLE, MA 02143-1408
(617) 665-1000
Mailing address
230 HIGHLAND AVE, SOMERVILLE, MA 02143-1408
(617) 665-1000
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
01073
MD
213E00000X
Podiatrist
Primary
2358
MA
213E00000X
Podiatrist
PO558
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110084502A
—
MA
Enumeration date
05/04/2006
Last updated
12/08/2011
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