Provider Demographics
NPI:1144427907
Name:LOUIS C. TEGTMEYER, D.O. P.C.
Entity Type:Organization
Organization Name:LOUIS C. TEGTMEYER, D.O. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:C
Authorized Official - Last Name:TEGTMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:734-762-9111
Mailing Address - Street 1:35600 CENTRAL CITY PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-2046
Mailing Address - Country:US
Mailing Address - Phone:734-762-9111
Mailing Address - Fax:734-762-9113
Practice Address - Street 1:35600 CENTRAL CITY PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185
Practice Address - Country:US
Practice Address - Phone:734-762-9111
Practice Address - Fax:734-762-9113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101010517208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI113331910Medicaid
MI0258209255OtherBLUE CROSS BLUE SHIELD
MI0258209255OtherBLUE CROSS BLUE SHIELD
MI0M34020Medicare PIN
MI0258209255OtherBLUE CROSS BLUE SHIELD