Provider Demographics
NPI:1275940371
Name:TEDESCO, ANTHONY (DO)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:TEDESCO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:ANTHONY
Other - Middle Name:
Other - Last Name:TEDESCO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:202 4TH AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:GRINNELL
Mailing Address - State:IA
Mailing Address - Zip Code:50112-1898
Mailing Address - Country:US
Mailing Address - Phone:515-224-1414
Mailing Address - Fax:515-224-5140
Practice Address - Street 1:202 4TH AVE STE 201
Practice Address - Street 2:
Practice Address - City:GRINNELL
Practice Address - State:IA
Practice Address - Zip Code:50112-1898
Practice Address - Country:US
Practice Address - Phone:515-224-1414
Practice Address - Fax:515-224-5140
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-21
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADO-05615207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty