Provider Demographics
NPI:1174802334
Name:TESIC, GORAN (MD)
Entity type:Individual
Prefix:
First Name:GORAN
Middle Name:
Last Name:TESIC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7700 LAKEVIEW PKWY STE C
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75088-4362
Mailing Address - Country:US
Mailing Address - Phone:972-487-1818
Mailing Address - Fax:972-487-7928
Practice Address - Street 1:7700 LAKEVIEW PKWY STE C
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-4362
Practice Address - Country:US
Practice Address - Phone:972-487-1818
Practice Address - Fax:972-487-7928
Is Sole Proprietor?:No
Enumeration Date:2011-08-05
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY125715208600000X
TXR84992086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery