Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 2301008012 | MI |
N | 111NN0400X | Neurology | 2301008012 | MI |
N | 111NN1001X | Nutrition | 2301008012 | MI |
N | 111NR0200X | Radiology | 2301008012 | MI |
N | 213ER0200X | Radiology | 2301008012 | MI |
NPI | 1982671012 |
---|---|
Provider Name | Timothy John Tersigni |
First Address | Fowlerville, MI 48836-1126 |
Second Address | Fowlerville, MI 48836-8901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2006 |
Last Update Date | 19/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
950D750420 | BCBS PIN (01) | MI |
U90362 | (02) | MI |