Provider Demographics
NPI:1952414385
Name:MICHAEL B TEIGER MD PC
Entity type:Organization
Organization Name:MICHAEL B TEIGER MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:TEIGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-278-3812
Mailing Address - Street 1:800 COTTAGE GROVE RD BLDG 5
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-4235
Mailing Address - Country:US
Mailing Address - Phone:860-278-3812
Mailing Address - Fax:860-525-6054
Practice Address - Street 1:800 COTTAGE GROVE RD BLDG 5
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002
Practice Address - Country:US
Practice Address - Phone:860-278-3812
Practice Address - Fax:860-525-6054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004206547Medicaid