Individual
MICHAEL RUSSELL TEKAUTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1524 MCHENRY AVE, SUITE 100, MODESTO, CA 95350-4500
(209) 577-4444
(209) 527-2069
Mailing address
101 PARK AVE, MODESTO, CA 95354-0556
(209) 571-6622
(209) 527-2069
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
G42730
CA
2085R0202X
Diagnostic Radiology Physician
Primary
G42730
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G427300
—
CA
Enumeration date
06/16/2006
Last updated
08/12/2008
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