Provider Demographics
NPI:1437133543
Name:TEODORESCU, MATEI (MD)
Entity Type:Individual
Prefix:
First Name:MATEI
Middle Name:
Last Name:TEODORESCU
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 1:425 7TH ST NW
Mailing Address - Street 2:
Mailing Address - City:CASS LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:56633-3360
Mailing Address - Country:US
Mailing Address - Phone:218-335-3200
Mailing Address - Fax:
Practice Address - Street 1:425 7TH ST NW
Practice Address - Street 2:
Practice Address - City:CASS LAKE
Practice Address - State:MN
Practice Address - Zip Code:56633-3360
Practice Address - Country:US
Practice Address - Phone:218-335-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN44112208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA544668Medicaid
MNA044OtherCHAMPUS
MN71613800Medicaid
MNMH9041028422OtherPPO
MN141035Medicaid
MN7309OtherAVERA
MN12-02485OtherMEDICA
MN46G55TEOtherBCBS
MN46G55TEOtherBCBS/MEDICARE SUPPLEMENT
MN1415252OtherARAZ
MN46G55TEMedicaid
MNHP33897OtherHEALTH PARTNERS
MN370002938Medicare ID - Type UnspecifiedRAILROAD MEDICARE
MN370002938Medicare ID - Type UnspecifiedMEDICARE
MNHP33897OtherHEALTH PARTNERS
MN71613800Medicaid