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Individual

THEODORE GEORGE ENGELMANN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DO

Contact information

Practice address
1990 UNION LAKE RD STE 100, COMMERCE TWP, MI 48382-2200
(248) 303-4680
(248) 572-4995
Mailing address
PO BOX 355, LAKEVILLE, MI 48366-0355
(248) 303-4680
(248) 572-4995

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
TE007018
MI
208D00000X
General Practice Physician
Primary
TE007018
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0F34006
BLUE CROSS BLUE SHIELD
MI
01
0H74439
BCBS
MI
05
4861124
MI
Enumeration date
07/24/2006
Last updated
07/15/2024
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