Provider Demographics
NPI:1558378570
Name:TESSMER, ANNE MARIE (PAC)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:MARIE
Last Name:TESSMER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:MARIE
Other - Last Name:BLASEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PAC
Mailing Address - Street 1:18325 10 MILE ROAD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-4990
Mailing Address - Country:US
Mailing Address - Phone:586-775-4594
Mailing Address - Fax:586-775-4506
Practice Address - Street 1:18325 10 MILE ROAD
Practice Address - Street 2:SUITE 400
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-4990
Practice Address - Country:US
Practice Address - Phone:586-775-4594
Practice Address - Fax:586-775-4506
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601003175363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI065 501 3550OtherBCBS
MIQ50187Medicare UPIN
MIOH-26467019Medicare PIN