Provider Demographics
NPI:1548562986
Name:THOMAS E. TESKE, M.D., INC
Entity Type:Organization
Organization Name:THOMAS E. TESKE, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:TESKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-337-4100
Mailing Address - Street 1:1745 SOUTH IMPERIAL AVENUE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-4243
Mailing Address - Country:US
Mailing Address - Phone:760-337-4100
Mailing Address - Fax:760-337-4101
Practice Address - Street 1:1745 SOUTH IMPERIAL AVENUE
Practice Address - Street 2:SUITE 101
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-4243
Practice Address - Country:US
Practice Address - Phone:760-337-4100
Practice Address - Fax:760-337-4101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG655182084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G655181Medicaid
CA00G655181Medicaid