1679576821 NPI number — REBECCA P TISCH M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679576821 NPI number — REBECCA P TISCH M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

TISCH

Provider First Name:

REBECCA

Provider Middle Name:

P

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1679576821

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

07/08/2007

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

7949 N CANTON CENTER RD

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

CANTON

Provider Business Mailing Address State Name:

MI

Provider Business Mailing Address Postal Code:

48187-1533

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

734-459-7850

Provider Business Mailing Address Fax Number:

734-459-5799

Provider First Line Business Practice Location Address:

7949 N CANTON CENTER RD

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

CANTON

Provider Business Practice Location Address State Name:

MI

Provider Business Practice Location Address Postal Code:

48187-1533

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

734-459-7850

Provider Business Practice Location Address Fax Number:

734-459-5799

Provider Enumeration Date:

05/23/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207W00000X , with the licence number:  4301407480 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 1505581001 . This is a "CIGNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
• Identifier: P50982 . This is a "BLUE CARE NETWORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
• Identifier: 000000004109 . This is a "CAPE MEDICAID" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
• Identifier: 4301407480 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
• Identifier: 103675 . This is a "CARE CHOICES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
• Identifier: 1208226271 . This is a "BLUE CROSS AND BLUE SHIEL" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
• Identifier: 2667834 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
• Identifier: 4123804 . This is a "AETNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
• Identifier: 79834 . This is a "ONE HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
• Identifier: B6710 . This is a "MCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 028226 . This is a "MIDWEST HEALTH" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
• Identifier: 15709 . This is a "SPECTERA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".