Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | 35038174 | OH |
NPI | 1144218272 |
---|---|
Provider Name | Douglas William Teske |
First Address | Columbus, OH 43205-2654 |
Second Address | Columbus, OH 43205-2654 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2005 |
Last Update Date | 02/12/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0105638000 | MEDICAID (01) | WV |
0296586 | (05) | OH |
64789084 | MEDICAID (01) | KY |
A75772 | (02) |