Provider Demographics
NPI:1316929250
Name:PROCTOR, TODD B (MD)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:B
Last Name:PROCTOR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2251 N SQUIRREL RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:AUBURN HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48326-4600
Mailing Address - Country:US
Mailing Address - Phone:248-648-8100
Mailing Address - Fax:248-648-8060
Practice Address - Street 1:2251 N SQUIRREL RD
Practice Address - Street 2:SUITE 105
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-4600
Practice Address - Country:US
Practice Address - Phone:248-648-8100
Practice Address - Fax:248-648-8060
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2018-02-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301054694207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3394295Medicaid
MI0M23890OtherMEDICARE GROUP #
040631293OtherBCBSM
040631293OtherBCBSM
MI0M23890001Medicare PIN