Provider Demographics
NPI:1942257639
Name:TENISON, MICHAEL DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DAVID
Last Name:TENISON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4197 REED ST
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-3741
Mailing Address - Country:US
Mailing Address - Phone:503-919-1664
Mailing Address - Fax:
Practice Address - Street 1:151 N SUNRISE AVE STE 1201
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2961
Practice Address - Country:US
Practice Address - Phone:916-780-0110
Practice Address - Fax:916-536-7241
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD270802083X0100X
MO20230250722083X0100X
NV242252083X0100X
CAC1553792083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR247407Medicaid
WA8429540Medicaid
OR247407Medicaid
ORR137681Medicare PIN