Healthcare Provider Details

I. General information

NPI: 1083765028
Provider Name (Legal Business Name): ROBERT A TEITGE MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3272 E 12 MILE RD SUITE 108
WARREN MI
48092-5622
US

IV. Provider business mailing address

3272 E 12 MILE RD SUITE 108
WARREN MI
48092-5622
US

V. Phone/Fax

Practice location:
  • Phone: 586-573-3100
  • Fax: 586-573-7924
Mailing address:
  • Phone: 586-573-3100
  • Fax: 586-573-7924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number4301042363
License Number StateMI

VIII. Authorized Official

Name: ROBERT A TEITGE
Title or Position: PRESIDENT
Credential: MD
Phone: 586-573-3100