Provider Demographics
NPI:1780776039
Name:HESSEL, TRACEY MICHELLE (MD)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:MICHELLE
Last Name:HESSEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:300 PROFESSIONAL CENTER DR
Mailing Address - Street 2:SUITE 311
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-4334
Mailing Address - Country:US
Mailing Address - Phone:415-448-1555
Mailing Address - Fax:415-892-8732
Practice Address - Street 1:400 PROFESSIONAL CENTER DR
Practice Address - Street 2:SUITE 424
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94947-4367
Practice Address - Country:US
Practice Address - Phone:415-448-1555
Practice Address - Fax:415-892-8732
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA78717208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics