Provider Demographics
NPI:1740367036
Name:TESARZ, KRISTI A (PA C)
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:A
Last Name:TESARZ
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1544 OLD BRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-1241
Mailing Address - Country:US
Mailing Address - Phone:734-394-1671
Mailing Address - Fax:
Practice Address - Street 1:26206 W 12 MILE RD STE 202
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-8500
Practice Address - Country:US
Practice Address - Phone:248-827-7612
Practice Address - Fax:248-827-7615
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2014-03-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5601004922363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant