Individual
MICHAEL T TETZLAFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, PHD
Contact information
Practice address
1515 HOLCOMBE BLVD, HOUSTION, TX 77030-4009
(713) 792-6161
Mailing address
PO BOX 4439, HOUSTON, TX 77210-4439
(713) 792-2991
Taxonomy
Speciality
Code
Description
License number
State
207ZD0900X
Dermatopathology (Pathology) Physician
Primary
N6711
TX
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
MT185963
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
214426301
—
TX
01
—
8CL001
BCBS
TX
01
—
P00881574
RRMEDICARE
TX
Enumeration date
01/02/2007
Last updated
04/10/2020
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