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General NPI Number Information
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NPI Number | 1316966906
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Entity Type | Individual
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Provider Name | THERESA VETTESE MD
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Gender | Female
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 11/08/2013
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Provider Practice Location Address
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Address Line | 50 E CANFIELD GENERAL MEDICINE AMBULATORY PRACTICE
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City | DETROIT
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State | MI
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Zip | 48201-1804
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Country | US
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Telephone | 313-745-4525
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Fax | 313-966-7305
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Provider Business Mailing Address
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Address Line | 1420 STEPHENSON HWY SUITE 400-CREDENTIALING
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City | TROY
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State | MI
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Zip | 48083-1189
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Country | US
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Telephone | 248-581-5972
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Fax | 248-581-5640
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301057647
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207RH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Internal Medicine) Physician
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License Number | 4301057647
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License Number State | MI
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