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Individual
MR. DEREK ROBERT TESORO
Active
Individual
MR. DEREK ROBERT TESORO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
DT001450
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11290415
CAQH
—
05
—
3173006
—
MI
01
—
480019411
MEDICARE RAILROAD
—
01
—
4857311150
BLUE CROSS
—
Enumeration date
11/02/2006
Last updated
05/15/2008
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