MEDICARE: DR. TERESA BLEAKLY KORTZ M.D., MS

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	208000000X	Pediatrics Physician	A109795	CA
2	2080P0203X	Pediatric Critical Care Medicine Physician	A109795	CA

General Provider Information

NPI Number	:	1881854990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERESA BLEAKLY KORTZ M.D., MS

Provider Business Mailing Address
First Line	:	UCSF DEPARTMENT OF PEDIATRICS, MAILCODE 0106
Second Line	:	550 16TH STREET, 5TH FLOOR
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94143
Country	:	US
Telephone Number	:	415-502-5825
Fax Number	:

Provider Business Practice Location Address
First Line	:	550 16TH ST FL 5
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94143-2549
Country	:	US
Telephone Number	:	415-502-5825
Fax Number	:

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

Provider Enumeration Date	:	06/12/2008
Last Update Date	:	01/15/2019

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