Healthcare Provider Details

I. General information

NPI: 1942257639
Provider Name (Legal Business Name): MICHAEL DAVID TENISON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 N SUNRISE AVE STE 1205
ROSEVILLE CA
95661-2932
US

IV. Provider business mailing address

4197 REED ST
WEST LINN OR
97068-3741
US

V. Phone/Fax

Practice location:
  • Phone: 916-780-0110
  • Fax: 916-536-7241
Mailing address:
  • Phone: 503-919-1664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberMD27080
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberC155379
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number2023025072
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number24225
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: