Organization Name: | MICHAEL P. TESSLER MD |
NPI Number: | 1356702021 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MICHAEL TESSLER (OWNER) |
Mailing Address: | 232 Southpark Cir E Saint Augustine |
State: | FL US |
Postal Code: | 320865137 |
Phone Number: | 9048292141 |
Fax Number: | 9048292141 |
NPI Enumeration Date: | 03/09/2016 |
NPI Last Update Date: | 03/09/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | ME33096 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |