Healthcare Provider Details

I. General information

NPI: 1477508752
Provider Name (Legal Business Name): PAUL TEIE
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 DELAWARE RD
FREDERICK MD
21701-4618
US

IV. Provider business mailing address

5000 CHESHIRE LN N
PLYMOUTH MN
55446-3706
US

V. Phone/Fax

Practice location:
  • Phone: 301-663-0553
  • Fax: 301-663-4189
Mailing address:
  • Phone: 888-333-9152
  • Fax: 763-268-4240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number00662
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: