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General NPI Number Information
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NPI Number | 1871778647
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Entity Type | Organization
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Legal Business Name | SAGINAW VALLEY FOOT & ANKLE CENTER
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Dates
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Enumeration Date | 12/29/2007
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Last Update Date | 05/15/2008
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Provider Practice Location Address
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Address Line | 5400 MACKINAW SUITE 2100
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City | SAGINAW
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State | MI
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Zip | 48604-9549
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Country | US
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Telephone | 989-790-4662
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Fax | 989-790-7680
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Provider Business Mailing Address
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Address Line | 5400 MACKINAW SUITE 2100
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City | SAGINAW
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State | MI
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Zip | 48604-9549
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Country | US
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Telephone | 989-790-4662
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Fax | 989-790-7680
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Authorized Official
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Title or Position | OWNER PHYSICIAN
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Name | MR. DEREK ROBERT TESORO
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Credential | DPM
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Telephone | 989-790-4662
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | DT001450
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License Number State | MI
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