MEDICARE: TED S WEN MD

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	2085R0202X	Diagnostic Radiology Physician	H8505	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	80070R	OTHER	TX	PTAN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982662623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TED S WEN MD

Provider Business Mailing Address
First Line	:	1820 PRESTON PARK BLVD
Second Line	:	STE 1825
City	:	PLANO
State	:	TX
Zip	:	75093-5215
Country	:	US
Telephone Number	:	972-867-7862
Fax Number	:

Provider Business Practice Location Address
First Line	:	6200 W PARKER RD
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-7939
Country	:	US
Telephone Number	:	972-608-8000
Fax Number	:

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

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	11/28/2023

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