Provider Demographics
NPI:1134092489
Name:DR TEDDY PLLC
Entity type:Organization
Organization Name:DR TEDDY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TEWODROS
Authorized Official - Middle Name:
Authorized Official - Last Name:TEKETEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-258-7081
Mailing Address - Street 1:29514 HIGHLAND MANOR CT
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-7778
Mailing Address - Country:US
Mailing Address - Phone:510-258-7081
Mailing Address - Fax:866-732-7319
Practice Address - Street 1:29514 HIGHLAND MANOR CT
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-7778
Practice Address - Country:US
Practice Address - Phone:510-258-7081
Practice Address - Fax:866-732-7319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-24
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty