Healthcare Provider Details

I. General information

NPI: 1255630943
Provider Name (Legal Business Name): TEDDY TONY TEHENSKY JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2011
Last Update Date: 03/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 WASHINGTON
MONROE MI
48161
US

IV. Provider business mailing address

17 WASHINGTON ST
MONROE MI
48161-2508
US

V. Phone/Fax

Practice location:
  • Phone: 734-322-3365
  • Fax:
Mailing address:
  • Phone: 734-322-3365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number3501005090
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: