Organization
SAGINAW VALLEY FOOT & ANKLE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DEREK ROBERT TESORO DPM (OWNER PHYSICIAN)
(989) 790-4662
Entity
Organization
Contact information
Practice address
5400 MACKINAW, SUITE 2100, SAGINAW, MI 48604-9549
(989) 790-4662
(989) 790-7680
Mailing address
5400 MACKINAW, SUITE 2100, SAGINAW, MI 48604-9549
(989) 790-4662
(989) 790-7680
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
DT001450
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11290415
CAQH
MI
01
—
1198630001
MEDICARE SUPPLIER ID
MI
05
—
3173006
—
MI
01
—
480019411
MEDICARE RAILROAD
MI
01
—
4857311150
BLUE CROSS
MI
Enumeration date
12/29/2007
Last updated
05/15/2008
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