Provider Demographics
NPI:1184118978
Name:TESSMER, CHANTEL (MD)
Entity type:Individual
Prefix:
First Name:CHANTEL
Middle Name:
Last Name:TESSMER
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 1:4535 WINDERWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-2639
Mailing Address - Country:US
Mailing Address - Phone:678-986-3297
Mailing Address - Fax:
Practice Address - Street 1:1325 COMMUNITY MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-2659
Practice Address - Country:US
Practice Address - Phone:708-245-8900
Practice Address - Fax:708-245-5777
Is Sole Proprietor?:No
Enumeration Date:2018-06-15
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
125073123390200000X
FLME158472207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program