Provider Demographics
NPI:1285835215
Name:ALLEN N.TESSER, M.D, P.C.
Entity Type:Organization
Organization Name:ALLEN N.TESSER, M.D, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALLLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:TESSER
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:586-939-6400
Mailing Address - Street 1:3058 METROPOLITAN PKWY
Mailing Address - Street 2:SUITE 208
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-3671
Mailing Address - Country:US
Mailing Address - Phone:586-939-6400
Mailing Address - Fax:
Practice Address - Street 1:3058 METROPOLITAN PKWY
Practice Address - Street 2:SUITE 208
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-3671
Practice Address - Country:US
Practice Address - Phone:586-939-6400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAT035199207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIAT035199OtherSTATE LICENSE
MIAT035199OtherSTATE LICENSE
MIB43751Medicare UPIN