Individual
SUSAN E TEGGATZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5409 AVENUE O, SUITE 1, FORT MADISON, IA 52627-9601
(319) 376-2134
(319) 376-2188
Mailing address
5409 AVENUE O, SUITE 1, FORT MADISON, IA 52627-9601
(319) 376-2134
(319) 376-2188
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
33739
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1578542668
WELLMARK BLUE CROSS BLUE SHIELD
IA
05
—
1578542668
—
IA
Enumeration date
01/17/2006
Last updated
10/06/2011
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