| Doctor Name: | DR. BIJI BOBY THECKEDATH |
| NPI Number: | 1073834735 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.D. |
| License Number: | 53600- 020 |
| Business Practice Address: | 6148 106 Th Ave. Kenosha, WI - 531427599 |
| Business Phone Number: | 6062260235 |
| Business Fax Number: | |
| Mailing Address: | 6148 106 Th Ave., KENOSHA |
| State: | WI |
| Postal Code: | 531427599 |
| Phone Number: | 6062260235 |
| Fax Number: | |
| NPI Enumeration Date: | 06/17/2010 |
| NPI Last Update Date: | 05/15/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 53600- 020 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | WI |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |