Physician Compare National (NPI:1891873022)

HEALTHCARE PROVIDER: DEREK ROBERT TESORO DPM

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1891873022
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9032245865
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100331000123
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	TESORO
	Individual professional last name
Provider First Name	DEREK
	Individual professional first name
Provider Middle Name	R
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	NEW YORK COLLEGE OF PODIATRIC MEDICINE
	Individual professional's medical school
Graduation Year	1988
	Individual professional's medical school graduation year
Primary Specialty	PODIATRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	5400 MACKINAW RD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 2100
	Group Practice or individual's line 2 address
City	SAGINAW
	Group Practice or individual's city
State	MI
	Group Practice or individual's state
Zip Code	486049549
	Group Practice or individual's zip code (9 digits when available)
Phone Number	9897904662
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	230070
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	COVENANT MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y