Provider Demographics
NPI:1417064528
Name:TESKA, DANIEL A (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:A
Last Name:TESKA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1249 N SUNNYSLOPE DRIVE
Mailing Address - Street 2:UNIT 205
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53406-3486
Mailing Address - Country:US
Mailing Address - Phone:262-497-9610
Mailing Address - Fax:
Practice Address - Street 1:3805B SPRING STREET
Practice Address - Street 2:SUITE 230
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53405-1640
Practice Address - Country:US
Practice Address - Phone:262-687-4479
Practice Address - Fax:262-687-5375
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI1789-023363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41995700Medicaid