Provider Demographics
NPI:1407881543
Name:SCHISLER, TESSA BLYTHE (DO)
Entity Type:Individual
Prefix:DR
First Name:TESSA
Middle Name:BLYTHE
Last Name:SCHISLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 E VERMONT ST
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-4963
Mailing Address - Country:US
Mailing Address - Phone:989-892-4586
Mailing Address - Fax:989-892-2901
Practice Address - Street 1:701 E VERMONT ST
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-4963
Practice Address - Country:US
Practice Address - Phone:989-892-4586
Practice Address - Fax:989-892-2901
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITS015867207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MITS015867OtherMI LICENSE
MII57193Medicare UPIN