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General NPI Number Information
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NPI Number | 1750573721
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Entity Type | Organization
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Legal Business Name | TISA K TESTAI DO.,PC
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Dates
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Enumeration Date | 08/14/2007
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Last Update Date | 03/28/2011
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Provider Practice Location Address
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Address Line | 1460 WALTON BLVD SUITE 206
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City | ROCHESTER HILLS
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State | MI
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Zip | 48309-1768
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Country | US
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Telephone | 248-651-9700
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Fax | 248-651-9701
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Provider Business Mailing Address
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Address Line | 1460 WALTON BLVD SUITE 206
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City | ROCHESTER HILLS
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State | MI
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Zip | 48309-1768
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Country | US
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Telephone | 248-651-9700
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Fax | 248-651-9701
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Authorized Official
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Title or Position | DOCTOR
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Name | TISA K TESTAI
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Credential | DO
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Telephone | 248-651-9700
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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 | TG011081
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License Number State | MI
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