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1437133543

NPI Code Detail

MEDICARE: MATEI TEODORESCU M.D.

MEDICARE: MATEI TEODORESCU M.D.

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	208000000X	Pediatrics Physician	44112	MN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
9	46G55TE	OTHER	MN	BCBS/MEDICARE SUPPLEMENT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	A044	OTHER	MN	CHAMPUS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MH9041028422	OTHER	MN	PPO
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	7309	OTHER	MN	AVERA
7	12-02485	OTHER	MN	MEDICA
8	46G55TE	OTHER	MN	BCBS
10	1415252	OTHER	MN	ARAZ
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	HP33897	OTHER	MN	HEALTH PARTNERS

General Provider Information

NPI Number	:	1437133543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATEI TEODORESCU M.D.

Provider Business Mailing Address
First Line	:	425 7TH ST NW
Second Line	:
City	:	CASS LAKE
State	:	MN
Zip	:	56633-3360
Country	:	US
Telephone Number	:	218-335-3200
Fax Number	:

Provider Business Practice Location Address
First Line	:	425 7TH ST NW
Second Line	:
City	:	CASS LAKE
State	:	MN
Zip	:	56633-3360
Country	:	US
Telephone Number	:	218-335-3200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2005
Last Update Date	:	05/28/2013

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1194754382 — DEPARTMENT OF HEALTH & HUMAN SERVICES PHS IHS
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Practice Fax: 218-335-3204

1639186752 — ALICE KATHLEEN LINGEN MD
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Directions to “ MATEI TEODORESCU M.D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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