Tesoro, Derek Robert

Tesoro, Derek Robert is an individual health care provider with primary practice located at 5400 Mackinaw Suite 2100, Saginaw MI 48604-9549. He recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Podiatrist, which is considered as his primary health care specialty. Tesoro, Derek Robert can be contacted via phone (989) 790-4662.

Contact Information

Primary practice address
5400 Mackinaw Suite 2100 Saginaw MI 48604-9549
Phone: (989) 790-4662
Fax: (989) 790-7680
Website:
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Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Podiatrist 213E00000X DT001450 Michigan

Profile Details

NPI number 1891873022
LBN Legal business name Tesoro, Derek Robert
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 2nd, 2006
Last updated May 15th, 2008 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1891873022 NPPES
Michigan MEDICAID 3173006
Michigan Other 480019411
Michigan Other 4857311150
Michigan Other 11290415

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