Provider Demographics
NPI:1679576821
Name:TISCH, REBECCA P (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:P
Last Name:TISCH
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:7949 N CANTON CENTER RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-1533
Mailing Address - Country:US
Mailing Address - Phone:734-459-7850
Mailing Address - Fax:734-459-5799
Practice Address - Street 1:7949 N CANTON CENTER RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-1533
Practice Address - Country:US
Practice Address - Phone:734-459-7850
Practice Address - Fax:734-459-5799
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-23
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MI4301407480207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1505581001OtherCIGNA
MIP50982OtherBLUE CARE NETWORK
MI000000004109OtherCAPE MEDICAID
MI4301407480OtherSTATE LICENSE NUMBER
MI103675OtherCARE CHOICES
MI1208226271OtherBLUE CROSS AND BLUE SHIEL
MI2667834Medicaid
MI4123804OtherAETNA
MI79834OtherONE HEALTH PLAN
MAB6710OtherMCARE
MI028226OtherMIDWEST HEALTH
MI15709OtherSPECTERA
MI2667834Medicaid
MI028226OtherMIDWEST HEALTH