Provider Demographics
NPI:1629037619
Name:TEOTIA, SUMEET SOREL (MD)
Entity Type:Individual
Prefix:
First Name:SUMEET
Middle Name:SOREL
Last Name:TEOTIA
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:PO BOX 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-5347
Mailing Address - Country:US
Mailing Address - Phone:214-645-2353
Mailing Address - Fax:214-645-2354
Practice Address - Street 1:1801 INWOOD RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-9132
Practice Address - Country:US
Practice Address - Phone:214-645-2353
Practice Address - Fax:214-645-2354
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM21512086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX200012701Medicaid
TX200012702OtherCSHCN
TX200012701Medicaid