MEDICARE: TISA K TESTAI D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	5101011081	MI

General Provider Information

NPI Number	:	1134169766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TISA K TESTAI D.O.

Provider Business Mailing Address
First Line	:	633 SOUTH BLVD E STE 1200
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-5364
Country	:	US
Telephone Number	:	248-844-6000
Fax Number	:	248-844-6159

Provider Business Practice Location Address
First Line	:	633 SOUTH BLVD E STE 1200
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-5364
Country	:	US
Telephone Number	:	248-844-6000
Fax Number	:	248-844-6159

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	09/12/2023

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