MEDICARE: MICHAEL P. TESSLER 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	208D00000X	General Practice Physician	ME33096	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356702021
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL P. TESSLER MD

Provider Business Mailing Address
First Line	:	232 SOUTHPARK CIR E
Second Line	:
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32086-5137
Country	:	US
Telephone Number	:	904-829-2141
Fax Number	:	904-829-2141

Provider Business Practice Location Address
First Line	:	232 SOUTHPARK CIR E
Second Line	:
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32086-5137
Country	:	US
Telephone Number	:	904-829-2141
Fax Number	:	904-829-2141

Authorized Official
Title or Position	:	OWNER
Name	:	MICHAEL TESSLER
Credential	:	MD
Telephone Number	:	904-829-2141

Provider Enumeration Date	:	03/09/2016
Last Update Date	:	03/09/2016

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