MEDICARE: TELLURIAN, INC.

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	2084P0802X	Addiction Psychiatry Physician
2	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1164432118
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TELLURIAN, INC.

Provider Business Mailing Address
First Line	:	1053 WILLIAMSON ST
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53703-3525
Country	:	US
Telephone Number	:	608-258-3446
Fax Number	:	608-258-3445

Provider Business Practice Location Address
First Line	:	1053 WILLIAMSON ST
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53703-3525
Country	:	US
Telephone Number	:	608-258-3446
Fax Number	:	608-258-3445

Authorized Official
Title or Position	:	QUALITY ASSURANCE DIRECTOR
Name	:	ERICA L MUELLER
Credential	:
Telephone Number	:	608-204-8547

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	08/15/2022

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Directions to “TELLURIAN, INC. ” Practice Location

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