Provider Demographics
NPI:1588202253
Name:TESKA, MICHAEL SR
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:TESKA
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 1ST ST S
Mailing Address - Street 2:
Mailing Address - City:KINNEY
Mailing Address - State:MN
Mailing Address - Zip Code:55758-3000
Mailing Address - Country:US
Mailing Address - Phone:218-295-2930
Mailing Address - Fax:
Practice Address - Street 1:102 1ST ST S
Practice Address - Street 2:
Practice Address - City:KINNEY
Practice Address - State:MN
Practice Address - Zip Code:55758-3000
Practice Address - Country:US
Practice Address - Phone:218-295-2930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-12
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider