Provider Demographics
NPI:1811223498
Name:WERTHEIMER, TERESA MARIE (MD)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:MARIE
Last Name:WERTHEIMER
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 1:2134 HAMPTON PL
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-3691
Mailing Address - Country:US
Mailing Address - Phone:517-347-3000
Mailing Address - Fax:517-347-8393
Practice Address - Street 1:2134 HAMPTON PL
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-3691
Practice Address - Country:US
Practice Address - Phone:517-347-3000
Practice Address - Fax:517-347-8393
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-02
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301048709208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301048709Medicare UPIN