Healthcare Provider Details

I. General information

NPI: 1306801790
Provider Name (Legal Business Name): MING TENG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 JOHN NOLEN DR
MADISON WI
53713-1430
US

IV. Provider business mailing address

1104 JOHN NOLEN DR
MADISON WI
53713-1430
US

V. Phone/Fax

Practice location:
  • Phone: 608-251-6868
  • Fax: 608-241-4255
Mailing address:
  • Phone: 608-251-6868
  • Fax: 608-241-4255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number48220-020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: