Provider Demographics
NPI:1609827351
Name:TEVES QUALLER, DENISE A (MD)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:A
Last Name:TEVES QUALLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DENISE
Other - Middle Name:A
Other - Last Name:TEVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:DIVISION OF ENDOCRINOLOGY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-955-6724
Mailing Address - Fax:414-955-6210
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:DIVISION OF ENDOCRINOLOGY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-955-6724
Practice Address - Fax:414-955-6210
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI46647207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1609827351Medicaid
029906261WOtherHUMANA
029906261WOtherHUMANA
WI1609827351Medicaid