=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518139302
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TESSA B SCHISLER DO PLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/01/2008
-----------------------------------------------------
Last Update Date | 08/19/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 701 E VERMONT ST
-----------------------------------------------------
City | BAY CITY
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48706-4971
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-892-4586
-----------------------------------------------------
Fax | 989-892-2901
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 701 E VERMONT ST
-----------------------------------------------------
City | BAY CITY
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48706-4971
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-892-4586
-----------------------------------------------------
Fax | 989-892-2901
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSE MANAGET
-----------------------------------------------------
Name | CAROL ANN REED
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 989-892-4586
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 5101015867
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------