R CHASE THEBAULT

DETROIT, MI
NPI1699920082
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy207Q00000X Family Medicine
(Licence: MI  4301104510)
Enumeration Date2008-11-26
Last Update Date2022-05-18
Business Address
Dr. R CHASE THEBAULT M.D.
5716 MICHIGAN AVE
DETROIT, MI 48210-3039
Phone number: 313-554-1095
Mailing Address
Dr. R CHASE THEBAULT M.D.
559 W GRAND BLVD
DETROIT, MI 48216-2200
Phone number: 313-554-0485
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