| NPI | 1871778647 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEREK ROBERT TESORO Owner Physician 989-790-4662 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MI DT001450) |
| Enumeration Date | 2007-12-29 |
| Last Update Date | 2008-05-15 |