Basic Information
| Provider Information | |||||||||
| NPI: | 1740840305 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ADZEMOVIC | ||||||||
| FirstName: | TESSA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1500 E. MEDICAL CENTER D | ||||||||
| Address2: | 3116 TAUBMAN CENTER, SPC 5368 | ||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481095368 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7342326513 | ||||||||
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| Practice Location | |||||||||
| Address1: | 111 N HURON ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | YPSILANTI | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481972676 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7345477977 | ||||||||
| FaxNumber: | 7345477978 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2019 | ||||||||
| LastUpdateDate: | 06/17/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 4351044144 | MI | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.