Provider Demographics
NPI:1629167473
Name:TETEN, BRETT WALTER (MD)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:WALTER
Last Name:TETEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:17 WEST EXCHANGE ST
Mailing Address - Street 2:#500
Mailing Address - City:ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102
Mailing Address - Country:US
Mailing Address - Phone:651-232-4200
Mailing Address - Fax:651-232-4119
Practice Address - Street 1:17 WEST EXCHANGE ST
Practice Address - Street 2:#500
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102
Practice Address - Country:US
Practice Address - Phone:651-232-4200
Practice Address - Fax:651-232-4119
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN41744207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN41744OtherSTATE MEDICAL LICENSE
MN713822900Medicaid
MN713822900Medicaid
G99116Medicare UPIN