Provider Demographics
NPI:1134420045
Name:SHIGYO, TETSUO TED (MD)
Entity type:Individual
Prefix:DR
First Name:TETSUO
Middle Name:TED
Last Name:SHIGYO
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 1:2763 W. WRENWOOD LN
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-2562
Mailing Address - Country:US
Mailing Address - Phone:559-431-3439
Mailing Address - Fax:
Practice Address - Street 1:2763 W WRENWOOD AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-2562
Practice Address - Country:US
Practice Address - Phone:559-431-3439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGFE27798207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine