Provider Demographics
NPI:1164617692
Name:MOLLER, TEKLA (MD)
Entity Type:Individual
Prefix:
First Name:TEKLA
Middle Name:
Last Name:MOLLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TEKLA
Other - Middle Name:
Other - Last Name:BINGMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1101 S. STATE ST.
Mailing Address - Street 2:#803
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605
Mailing Address - Country:US
Mailing Address - Phone:312-922-0898
Mailing Address - Fax:
Practice Address - Street 1:5841 S. MARYLAND AVE
Practice Address - Street 2:MC 6060
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637
Practice Address - Country:US
Practice Address - Phone:773-702-3056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-07
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics