Individual
DR. CHRISTOPHER L TISDEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6847 N CHESTNUT ST STE 105, RAVENNA, OH 44266-3929
(330) 297-6030
(330) 297-4919
Mailing address
44555 WOODWARD AVE STE 406, SUITE 407, PONTIAC, MI 48341-5036
(248) 334-0524
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
081413
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0630027
BLUE CROSS/BLUE SHIELD
MI
05
—
4513256
—
MI
Enumeration date
03/16/2006
Last updated
12/18/2020
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