Provider Demographics
NPI:1801888714
Name:TEITGE, ROBERT A (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:TEITGE
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 1:6525 W MAPLE RD
Mailing Address - Street 2:SUITE 101E
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322
Mailing Address - Country:US
Mailing Address - Phone:248-489-4410
Mailing Address - Fax:248-489-4420
Practice Address - Street 1:6525 W MAPLE RD
Practice Address - Street 2:SUITE 101E
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322
Practice Address - Country:US
Practice Address - Phone:248-489-4410
Practice Address - Fax:248-489-4420
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301042363207XX0005X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1801888714Medicaid
MI05006388201Medicare ID - Type Unspecified
MIMI3973497Medicare PIN
A40721Medicare UPIN
MI1801888714Medicaid