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General NPI Number Information
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NPI Number | 1851654966
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Entity Type | Individual
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Provider Name | TRENT MICHAEL TENNYSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/22/2012
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Last Update Date | 06/30/2021
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Provider Practice Location Address
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Address Line | 19401 HUBBARD DR
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City | DEARBORN
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State | MI
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Zip | 48126-2641
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Country | US
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Telephone | 313-982-8369
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Fax |
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Provider Business Mailing Address
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Address Line | 19401 HUBBARD DR
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City | DEARBORN
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State | MI
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Zip | 48126-2641
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Country | US
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Telephone | 313-982-8369
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Fax |
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | MT201280
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 25MA11085700
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 4301113830
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License Number State | MI
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