Individual
THEODORE J STANDIFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1500 E MEDICAL CENTER DR, ANN ARBOR, MI 48109-5000
(734) 936-4000
Mailing address
3621 S STATE ST, ANN ARBOR, MI 48108-1633
(734) 647-5299
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4301053979
MI
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
4301053979
MI
207RP1001X
Pulmonary Disease Physician
Primary
4301053979
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2702227
—
MI
Enumeration date
10/20/2006
Last updated
08/09/2019
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