Provider Demographics
NPI:1205906153
Name:TEPE, MICHAEL L
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:L
Last Name:TEPE
Suffix:
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 1:5739 1/2 WALNUT STREET
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15232
Mailing Address - Country:US
Mailing Address - Phone:412-363-6556
Mailing Address - Fax:412-363-6585
Practice Address - Street 1:5739 ONE HALF WALNUT STREET
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15232
Practice Address - Country:US
Practice Address - Phone:412-363-6556
Practice Address - Fax:412-363-6585
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006525L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA202001OtherUPMC
PA11536819OtherCAQH
PA336670 MTEPEOtherHEALTH AMERICA
PAPVR110Medicaid
PAT114853OtherIHP
PATE836539OtherBLUE CROSS BLUE SHIELD
PATE836539OtherMEDICARE PROVIDER ID
PATE836539OtherBLUE CROSS BLUE SHIELD