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NPI Code Detail

MEDICARE: GISLAINE TSEMO MD

MEDICARE: GISLAINE TSEMO 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
1207R00000XInternal Medicine Physician33889AZ

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P003J6264OTHERAZRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3AZ0781010OTHERAZBCBS

General Provider Information

NPI Number : 1851351068
Entity Type Code : Individual
Provider Name (Legal Business Name) : GISLAINE TSEMO MD
Provider Business Mailing Address
First Line : PO BOX 708850
Second Line :
City : SANDY
State : UT
Zip : 84070-8850
Country : US
Telephone Number : 866-869-2395
Fax Number : 801-352-9502
Provider Business Practice Location Address
First Line : 9201 W THOMAS RD
Second Line :
City : PHOENIX
State : AZ
Zip : 85037-3332
Country : US
Telephone Number : 623-327-7313
Fax Number : 623-327-5437
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2006
Last Update Date : 04/30/2008

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Directions to “ GISLAINE TSEMO MD” Practice Location

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