MEDICARE: DR. NICHOLAS A TEPE MD

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	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	4301051464	MI

General Provider Information

NPI Number	:	1205827060
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICHOLAS A TEPE MD

Provider Business Mailing Address
First Line	:	1663 W BIG BEAVER RD
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48084-3501
Country	:	US
Telephone Number	:	248-643-8533
Fax Number	:	248-643-8680

Provider Business Practice Location Address
First Line	:	1663 W BIG BEAVER RD
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48084-3501
Country	:	US
Telephone Number	:	248-643-8533
Fax Number	:	248-643-8680

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

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	07/08/2007

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