Provider Demographics
NPI:1932227907
Name:TENTORI, MICHAEL B (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:B
Last Name:TENTORI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 HOSPITAL DR
Mailing Address - Street 2:PO BOX 1239
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-6890
Mailing Address - Country:US
Mailing Address - Phone:573-406-5888
Mailing Address - Fax:573-248-5264
Practice Address - Street 1:6500 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-6890
Practice Address - Country:US
Practice Address - Phone:573-629-3330
Practice Address - Fax:573-629-3334
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO101770202C00000X, 207Q00000X
MODO1017702083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical Examiner
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1932227907Medicaid
MO137720008Medicare PIN