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General NPI Number Information
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NPI Number | 1942257639
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Entity Type | Individual
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Provider Name | MICHAEL DAVID TENISON M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/28/2006
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Last Update Date | 09/13/2023
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Provider Practice Location Address
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Address Line | 151 N SUNRISE AVE STE 1201
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City | ROSEVILLE
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State | CA
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Zip | 95661-2961
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Country | US
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Telephone | 916-780-0110
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Fax | 916-536-7241
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Provider Business Mailing Address
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Address Line | 4197 REED ST
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City | WEST LINN
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State | OR
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Zip | 97068-3741
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Country | US
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Telephone | 503-919-1664
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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 | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number | MD27080
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number | 2023025072
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number | 24225
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License Number State | NV
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Taxonomy #4
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Taxonomy Code | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number | C155379
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License Number State | CA
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