Provider Demographics
NPI:1245343672
Name:TEIGER, MICHAEL B (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:B
Last Name:TEIGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 N MAIN ST
Mailing Address - Street 2:FIRST FLR
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06117-2515
Mailing Address - Country:US
Mailing Address - Phone:860-278-3812
Mailing Address - Fax:860-525-6054
Practice Address - Street 1:345 N MAIN ST
Practice Address - Street 2:FIRST FLR
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06117-2515
Practice Address - Country:US
Practice Address - Phone:860-278-3812
Practice Address - Fax:860-525-6054
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT021525207R00000X, 207RP1001X
IN01079333207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001215250Medicaid
CT010021525CT02OtherANTHEM BLUE SHIELD
CT001215250Medicaid
CT010021525CT02OtherANTHEM BLUE SHIELD