Provider Demographics
NPI:1790722353
Name:MATTOO, TEJ K (MD)
Entity Type:Individual
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First Name:TEJ
Middle Name:K
Last Name:MATTOO
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Gender:M
Credentials:MD
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Mailing Address - Street 1:4201 ST. ANTOINE - UHC 5D MAILBOX 226
Mailing Address - Street 2:UNIVERSITY PEDIATRICIANS
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2153
Mailing Address - Country:US
Mailing Address - Phone:313-745-4405
Mailing Address - Fax:313-966-0665
Practice Address - Street 1:CHILDRENS HOSPITAL OF MICHIGAN
Practice Address - Street 2:3901 BEAUBIEN BLVD - NEPHROLOGY
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-745-5604
Practice Address - Fax:313-966-0039
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2019-07-25
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Provider Licenses
StateLicense IDTaxonomies
MI0687312080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology