Organization
TEWODROS FESSEHA, M.D., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TEWODROS FESSEHA M.D. (PRESIDENT)
(248) 552-8525
Entity
Organization
Contact information
Practice address
20905 GREENFIELD RD, SUITE 407, SOUTHFIELD, MI 48075-5360
(248) 552-8525
(248) 552-1134
Mailing address
20905 GREENFIELD RD, SUITE 407, SOUTHFIELD, MI 48075-5360
(248) 552-8525
(248) 552-1134
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
4101056254
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3406311902
BLUE CROSS
MI
05
—
4132714 10
—
MI
Enumeration date
09/28/2007
Last updated
09/28/2007
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