MEDICARE: STEPHANIE KATHRYN TEOTIA 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	208600000X	Surgery Physician	2005-01643	NC
2	2086S0122X	Plastic and Reconstructive Surgery Physician	P2194	TX

General Provider Information

NPI Number	:	1760601371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE KATHRYN TEOTIA M.D.

Provider Business Mailing Address
First Line	:	4231 CEDAR SPRINGS RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75219-2691
Country	:	US
Telephone Number	:	214-823-9652
Fax Number	:	214-823-4935

Provider Business Practice Location Address
First Line	:	4231 CEDAR SPRINGS RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75219-2691
Country	:	US
Telephone Number	:	214-823-9652
Fax Number	:	214-823-4935

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

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	12/02/2015

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