Individual
DR. BOBY G THECKEDATH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
8400 WASHINGTON AVE, MOUNT PLEASANT, WI 53406-3735
(262) 884-4000
(262) 884-4177
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
38387
KY
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
55991
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100216167
—
WI
05
—
64096845
—
KY
Enumeration date
04/10/2006
Last updated
10/14/2025
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