DR. R CHASE THEBAULT (NPI# 1699920082) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699920082 |
| Entity Type | Individual |
| Full Name | DR. R CHASE THEBAULT |
| Credential | M.D. |
| Practice Address |
5716 Michigan Ave Suite 1100 Detroit MI 48210-3039 |
| Mailing Address |
559 W Grand Blvd Detroit MI 48216-2200 |
| Practice Telephone | 3135541095 |
| Practice Fax Number | 3138993560 |
| Mailing Telephone | 3135540485 |
| Mailing Fax Number | 3132280283 |
| Enumeration Date | 2008-11-26 |
| Last Update Date | 2014-10-06 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 4301104510 | MI | Allopathic & Osteopathic Physicians |
| Street Address |
5716 MICHIGAN AVE SUITE 1100 |
| City | DETROIT |
| State | MI |
| Zip Code | 48210-3039 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205827573 | Lisa J Mcintosh | Obstetrics & Gynecology | 5716 Michigan Ave, Detroit, MI 48210-3039 | 2005-11-04 |
| 1891326625 | Gabriella Jamie Sanford | Social Worker | 5716 Michigan Ave, Detroit, MI 48210-3039 | 2020-01-30 |
| 1972143782 | Joanna Veronica Dimas | Social Worker | 5716 Michigan Ave, Detroit, MI 48210-3039 | 2020-01-09 |
| 1720621279 | Rachel Campbell | Nurse Practitioner | 5716 Michigan Ave, Detroit, MI 48210-3039 | 2019-10-28 |
| 1326699752 | Carmensita J Buentello | Counselor | 5716 Michigan Ave, Detroit, MI 48210-3039 | 2019-09-26 |
| 1316598329 | Disheka Denise Beverly-daniels | Social Worker | 5716 Michigan Ave, Detroit, MI 48210-3039 | 2019-09-23 |
| 1912552449 | Katharine Nicole Marquez | Social Worker | 5716 Michigan Ave, Detroit, MI 48210-3039 | 2019-08-01 |
| 1174183057 | Katherine Byl | Physician Assistant | 5716 Michigan Ave, Detroit, MI 48210-3039 | 2019-06-13 |
| 1760955124 | Hawa A Haji-hassan | Student in an Organized Health Care Education/Training Program | 5716 Michigan Ave, Detroit, MI 48210-3039 | 2019-01-09 |
| 1962975631 | Emma Jean Urbain | Social Worker | 5716 Michigan Ave, Detroit, MI 48210-3039 | 2019-01-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518517606 | Southwest Solutions | Counselor | 5716 Michigan, Detroit, MI 48210 | 2019-09-19 |
| 1942676150 | Audrey Hall | Case Manager/Care Coordinator | 6576 Woodrow St, Detroit, MI 48210 | 2015-08-12 |
| 1952705147 | Barbara Denise Mccowin-west | Technician, Other | 6900 Mcgraw, Detroit, MI 48210 | 2014-10-16 |
| 1922259456 | Dawn Marie Sanderson | Counselor | 5613 Livernois, Detroit, MI 48210 | 2008-10-02 |
| 1366552804 | American Indian Health and Family Services of Southeastern Mi Inc | In Home Supportive Care | 4880 Lawndalestreet, Detroit, MI 48210 | 2006-08-30 |
| 1912950163 | Irwin Rabinowitz | Pharmacist | Junction Clinic Pharmacy 4771 Michigan Ave., Detroit, MI 48210 | 2006-05-18 |
| 1538305909 | Barbara Ann Menzies-williams | Internal Medicine | 6550 W Warren Ave, Detroit, MI 48210 | 2009-01-06 |
| 1760678437 | Clement T Piaskowski | Optometrist | 7433 Michigan Ave, Detroit, MI 48210 | 2007-09-17 |
| 1083804173 | Detroit Medical Centre | General Acute Care Hospital | 4201 St. Antoine, Detroit, MI 48210 | 2007-07-26 |
| 1205030277 | Renaissance Dental PC | Dentist | 7330 W Warren Ave, Detroit, MI 48210-1041 | 2007-06-13 |
| Find all providers in zip 48210 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194354811 | Lorie Ann Turner | Family Medicine | 1728 Sheridan St, Detroit, MI 48214-2410 | 2020-04-04 |
| 1134787633 | Behavioral Health Professionals, Inc | Family Medicine | 19750 Burt Road, Detroit, MI 48219 | 2019-05-31 |
| 1508326687 | Randi Nguyen | Family Medicine | 22151 Moross Rd Ste 212, Detroit, MI 48236-2177 | 2019-03-23 |
| 1982194338 | Green Cross Medical Center PC | Family Medicine | 18041 Greenfield Rd, Detroit, MI 48235-3120 | 2018-05-11 |
| 1205339306 | Conant Family Care Pllc | Family Medicine | 3611 Carpenter St Ste 5, Detroit, MI 48212-2784 | 2018-03-14 |
| 1801303086 | St Mary Mercy Physician Practices | Family Medicine | 5555 Conner St Ste 2691, Detroit, MI 48213-3812 | 2018-01-09 |
| 1427408376 | Raquel Orlich | Family Medicine | 1620 Michigan Ave Ste 125, Detroit, MI 48216-1493 | 2016-06-21 |
| 1295181543 | Ammar Charestan | Family Medicine | 6071 Outer Dr W, Detroit, MI 48235 | 2016-05-05 |
| 1629423652 | Rajni Parmar | Family Medicine | 6001 W Outer Dr Ste 430, Detroit, MI 48235-2626 | 2016-04-27 |
| 1265886733 | Benjamin Abraham | Family Medicine | One Ford Place 2e, Henry Ford Hospital, Department of Family Medicine, Detroit, MI 48202 | 2016-04-20 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.