MEDICARE: REBECCA P TISCH M.D.

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
1	207W00000X	Ophthalmology Physician	4301407480	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1505581001	OTHER	MI	CIGNA
2	P50982	OTHER	MI	BLUE CARE NETWORK
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	4301407480	OTHER	MI	STATE LICENSE NUMBER
5	103675	OTHER	MI	CARE CHOICES
6	1208226271	OTHER	MI	BLUE CROSS AND BLUE SHIEL
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	4123804	OTHER	MI	AETNA
9	79834	OTHER	MI	ONE HEALTH PLAN
10	B6710	OTHER	MA	MCARE
11	028226	OTHER	MI	MIDWEST HEALTH
12	15709	OTHER	MI	SPECTERA

General Provider Information

NPI Number	:	1679576821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA P TISCH M.D.

Provider Business Mailing Address
First Line	:	7949 N CANTON CENTER RD
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48187-1533
Country	:	US
Telephone Number	:	734-459-7850
Fax Number	:	734-459-5799

Provider Business Practice Location Address
First Line	:	7949 N CANTON CENTER RD
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48187-1533
Country	:	US
Telephone Number	:	734-459-7850
Fax Number	:	734-459-5799

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	07/08/2007

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Directions to “ REBECCA P TISCH M.D.” Practice Location

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