Healthcare Provider Details

I. General information

NPI: 1366874000
Provider Name (Legal Business Name): MATTHEW JOSEPH TEFTELLER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2013
Last Update Date: 08/19/2021
Certification Date: 08/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3141 CENTENNIAL BLVD
COLORADO SPRINGS CO
80907-4094
US

IV. Provider business mailing address

3141 CENTENNIAL BLVD
COLORADO SPRINGS CO
80907-4094
US

V. Phone/Fax

Practice location:
  • Phone: 719-227-4690
  • Fax: 719-227-4667
Mailing address:
  • Phone: 719-227-4690
  • Fax: 719-227-4667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0000780
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: