Provider Demographics
NPI:1336138577
Name:TELLO, WAEL (MD)
Entity Type:Individual
Prefix:
First Name:WAEL
Middle Name:
Last Name:TELLO
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 1:4407 6TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416-4733
Mailing Address - Country:US
Mailing Address - Phone:806-771-5864
Mailing Address - Fax:806-771-9009
Practice Address - Street 1:4407 6TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79416-4733
Practice Address - Country:US
Practice Address - Phone:806-771-5864
Practice Address - Fax:806-771-9009
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2603207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM73124Medicaid
TX85451ZOtherHMO BLUE
TX125321102OtherFIRSTCARE STAR
NM73124OtherPRESBYTERIAN COMMERCIAL
TXP0120662OtherDPS
OK100045060AMedicaid
TX125321103OtherFIRSTCARE COMMERCIAL
TX100729604Medicaid
TX8F0100OtherBC/BS
NMA513OtherTRIWEST
TX100729603Medicaid
NMG5882Medicaid
NMG5882Medicaid
TX100729603Medicaid
TXBT4891392OtherDEA
TX100729604Medicaid