Doctor Name: | MATTHEW B TEOLIS |
NPI Number: | 1073508420 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DO |
License Number: | 02000701A |
Business Practice Address: | 24 Joliet St Dyer, IN - 463111705 |
Business Phone Number: | 2198642247 |
Business Fax Number: | 2198642147 |
Mailing Address: | Po Box 1000, DYER |
State: | IN |
Postal Code: | 463110800 |
Phone Number: | 2198642107 |
Fax Number: | 2198642649 |
NPI Enumeration Date: | 09/13/2005 |
NPI Last Update Date: | 02/08/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 207QA0401X |
License Number: | 02000701A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Family Medicine |
Taxonomy Specialization: | Addiction Medicine |
Taxonomy Definition: | A family medicine physician who specializes in the diagnosis and treatment of addictions. |