Provider Demographics
NPI:1477522803
Name:TECCA, JOHN E (PHD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:E
Last Name:TECCA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:576 ROMENCE RD
Mailing Address - Street 2:SUITE 121
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024
Mailing Address - Country:US
Mailing Address - Phone:269-324-0555
Mailing Address - Fax:269-324-2482
Practice Address - Street 1:576 ROMENCE RD
Practice Address - Street 2:SUITE 121
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024
Practice Address - Country:US
Practice Address - Phone:269-324-0555
Practice Address - Fax:269-324-2482
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI382865858051OtherCOMMUNITY CHOICE
MI540C90287OtherBCBS OF MI
MI640C92603OtherBCBS OF MI
MIOM29940Medicare ID - Type Unspecified