1558378570 NPI number — ANNE MARIE TESSMER PAC

Table of content: ANNE MARIE TESSMER PAC (NPI 1558378570)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558378570 NPI number — ANNE MARIE TESSMER PAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TESSMER
Provider First Name:
ANNE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PAC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BLASEN
Provider Other First Name:
ANNE
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PAC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1558378570
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/21/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18325 10 MILE ROAD
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
ROSEVILLE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48066-4990
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-775-4594
Provider Business Mailing Address Fax Number:
586-775-4506

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18325 10 MILE ROAD
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
ROSEVILLE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48066-4990
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-775-4594
Provider Business Practice Location Address Fax Number:
586-775-4506
Provider Enumeration Date:
08/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  5601003175 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 065 501 3550 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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