Individual
MR. DEREK ROBERT TESORO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
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
—
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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