MEDICARE: MR. LEO R TEYTELBAUM M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	ME0044110	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053388512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LEO R TEYTELBAUM M.D.

Provider Business Mailing Address
First Line	:	6450 38TH AVE N
Second Line	:	SUITE #350
City	:	ST PETERSBURG
State	:	FL
Zip	:	33710-1645
Country	:	US
Telephone Number	:	727-344-7339
Fax Number	:	727-343-8470

Provider Business Practice Location Address
First Line	:	6450 38TH AVE N
Second Line	:	SUITE #350
City	:	ST PETERSBURG
State	:	FL
Zip	:	33710-1645
Country	:	US
Telephone Number	:	727-344-7339
Fax Number	:	727-343-8470

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2006
Last Update Date	:	06/01/2012

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Directions to “ MR. LEO R TEYTELBAUM M.D.” Practice Location

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