Active NPI
Theodore G Pantos, MD
- Urology Physician
- Grosse Pointe Farms, MI
National Provider Identifier
1437363744
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Urology Physician
- License
- 4301023016
- Practice address
- 45 Warner Rd
Grosse Pointe Farms, MI 48236 - Phone
- (313) 881-5612
- NPI assigned
- May 9, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urology Physician | 208800000X | 4301023016 | MI | Primary |
Addresses
Primary practice location
45 Warner Rd
Grosse Pointe Farms, MI 48236
Mailing address
45 Warner Rd
Grosse Pointe Farms, MI 48236
Phone (313) 881-5612
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301023016 | MI | MD | Urology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178668800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1343952000000",
"number": "1437363744",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "45 WARNER RD",
"city": "GROSSE POINTE FARMS",
"state": "MI",
"postal_code": "48236",
"telephone_number": "313-881-5612"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "45 WARNER RD",
"city": "GROSSE POINTE FARMS",
"state": "MI",
"postal_code": "48236",
"telephone_number": "313-881-5612"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PANTOS",
"first_name": "THEODORE",
"middle_name": "G",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-09",
"last_updated": "2012-08-03",
"status": "A"
},
"taxonomies": [
{
"code": "208800000X",
"taxonomy_group": "",
"desc": "Urology",
"state": "MI",
"license": "4301023016",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grosse Pointe Farms, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.