Provider Demographics
NPI:1467458919
Name:HUO, TEH-LI T (MD)
Entity Type:Individual
Prefix:
First Name:TEH-LI
Middle Name:T
Last Name:HUO
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 1:2149 E WARNER RD STE 102
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-3495
Mailing Address - Country:US
Mailing Address - Phone:480-610-6100
Mailing Address - Fax:520-327-9300
Practice Address - Street 1:1645 N SWAN RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-4046
Practice Address - Country:US
Practice Address - Phone:520-623-2642
Practice Address - Fax:520-327-9300
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24443207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
125120OtherHEALTH NET INSURANCE
AZ35767503Medicaid
420889350OtherBC/BS OF ARIZONA
66302Medicare ID - Type Unspecified
420889350OtherBC/BS OF ARIZONA