MEDICARE: STEPHANIE K. TEOTIA MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0122X	Plastic and Reconstructive Surgery Physician	P2194	TX

General Provider Information

NPI Number	:	1083023303
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEPHANIE K. TEOTIA MD PA

Provider Business Mailing Address
First Line	:	4231 CEDAR SPRINGS RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75219-2691
Country	:	US
Telephone Number	:	214-823-9652
Fax Number	:	214-823-4935

Provider Business Practice Location Address
First Line	:	4231 CEDAR SPRINGS RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75219-2691
Country	:	US
Telephone Number	:	214-823-9652
Fax Number	:	214-823-4935

Authorized Official
Title or Position	:	PHYSICIAN/OWNER
Name	:	STEPHANIE K TEOTIA
Credential	:
Telephone Number	:	214-823-9652

Provider Enumeration Date	:	08/12/2014
Last Update Date	:	03/04/2015

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