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NPI Code Detail

MEDICARE: TEKETEL HANSEWO

MEDICARE: TEKETEL HANSEWO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist5302038552MI

General Provider Information

NPI Number : 1053942508
Entity Type Code : Individual
Provider Name (Legal Business Name) : TEKETEL HANSEWO
Provider Business Mailing Address
First Line : 2400 FORT ST
Second Line :
City : LINCOLN PARK
State : MI
Zip : 48146-2496
Country : US
Telephone Number : 313-381-2400
Fax Number :
Provider Business Practice Location Address
First Line : 2400 FORT ST
Second Line :
City : LINCOLN PARK
State : MI
Zip : 48146-2496
Country : US
Telephone Number : 313-381-2400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/03/2020
Last Update Date : 02/03/2020

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Directions to “ TEKETEL HANSEWO ” Practice Location

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