Healthcare Provider Details

I. General information

NPI: 1043224751
Provider Name (Legal Business Name): TERESA DAO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 WOODLAND DR
ELIZABETHTOWN KY
42701-2767
US

IV. Provider business mailing address

PO BOX 1476
ELIZABETHTOWN KY
42702-1476
US

V. Phone/Fax

Practice location:
  • Phone: 270-769-1371
  • Fax: 270-737-5870
Mailing address:
  • Phone: 270-769-1371
  • Fax: 270-737-5870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number24203
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: