MEDICARE: DR. PAUL LEO TECKLENBERG MD

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	207R00000X	Internal Medicine Physician		NC

General Provider Information

NPI Number	:	1669528022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL LEO TECKLENBERG MD

Provider Business Mailing Address
First Line	:	128 VOLLEY ROAD
Second Line	:
City	:	ELLENBORO
State	:	NC
Zip	:	28040-4710
Country	:	US
Telephone Number	:	828-248-1589
Fax Number	:	828-248-1589

Provider Business Practice Location Address
First Line	:	128 VOLLEY ROAD
Second Line	:
City	:	ELLENBORO
State	:	NC
Zip	:	28040-4710
Country	:	US
Telephone Number	:	828-248-1589
Fax Number	:	828-248-1589

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

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	07/08/2007

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