Provider Demographics
NPI:1790766004
Name:TELEHOWSKI, PAUL MATTHEW (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:MATTHEW
Last Name:TELEHOWSKI
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 1:4466 W BRISTOL RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-3170
Mailing Address - Country:US
Mailing Address - Phone:810-733-1200
Mailing Address - Fax:810-733-0688
Practice Address - Street 1:4466 W BRISTOL RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-3170
Practice Address - Country:US
Practice Address - Phone:810-733-1200
Practice Address - Fax:810-733-0688
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301072079207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0B51156OtherBLUE CROSS GROUP
MI4696067Medicaid
1215930490OtherTYPE 2 NPI
CB0923OtherGRP RAILROAD MEDICARE
MI4696085Medicaid
ON45090OtherGROUP MEDICARE #
1215930490OtherTYPE 2 NPI
MI4696067Medicaid