Provider Demographics
NPI:1386699601
Name:TEEL, DONOVAN D II (MD)
Entity type:Individual
Prefix:
First Name:DONOVAN
Middle Name:D
Last Name:TEEL
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:30 E APPLE ST
Mailing Address - Street 2:SUITE 6258
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409-2939
Mailing Address - Country:US
Mailing Address - Phone:937-208-5300
Mailing Address - Fax:937-208-5650
Practice Address - Street 1:30 E APPLE ST
Practice Address - Street 2:SUITE 6258
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-2939
Practice Address - Country:US
Practice Address - Phone:937-208-5300
Practice Address - Fax:937-208-5650
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.086270208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH02 GENERAL SURGEONOtherMEDICARE SPECIALITY DESIGNATION CODE
OH2594287Medicaid
OH02 GENERAL SURGEONOtherMEDICARE SPECIALITY DESIGNATION CODE
OH4163282Medicare PIN
OH2594287Medicare PIN
OH2594287Medicaid