Provider Demographics
NPI:1437152527
Name:GORDON, TESS M (MD)
Entity Type:Individual
Prefix:
First Name:TESS
Middle Name:M
Last Name:GORDON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 E WARWICK DR STE D
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:MI
Mailing Address - Zip Code:48801-1083
Mailing Address - Country:US
Mailing Address - Phone:989-466-5486
Mailing Address - Fax:989-466-5023
Practice Address - Street 1:315 E WARWICK DR STE D
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801-1083
Practice Address - Country:US
Practice Address - Phone:989-466-5486
Practice Address - Fax:989-466-5023
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35083886207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2489847Medicaid
OH2489847Medicaid
OH4133556Medicare PIN