MEDICARE: MR. ANGEL E TEJEDA 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	207RN0300X	Nephrology Physician	ME0065366	FL

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710905914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANGEL E TEJEDA M.D.

Provider Business Mailing Address
First Line	:	4305 E 8TH AVE
Second Line	:	SUITE C
City	:	HIALEAH
State	:	FL
Zip	:	33013-2465
Country	:	US
Telephone Number	:	305-693-6305
Fax Number	:	305-456-0082

Provider Business Practice Location Address
First Line	:	4305 E 8TH AVE
Second Line	:	SUITE C
City	:	HIALEAH
State	:	FL
Zip	:	33013-2465
Country	:	US
Telephone Number	:	305-693-6305
Fax Number	:	305-456-0082

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

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	11/22/2013

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