Provider Demographics
NPI:1528170909
Name:TELLOW, RIYADH J (MD)
Entity type:Individual
Prefix:DR
First Name:RIYADH
Middle Name:J
Last Name:TELLOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:807 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SIKESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63801-2171
Mailing Address - Country:US
Mailing Address - Phone:573-472-1321
Mailing Address - Fax:573-472-4053
Practice Address - Street 1:807 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SIKESTON
Practice Address - State:MO
Practice Address - Zip Code:63801-2171
Practice Address - Country:US
Practice Address - Phone:573-472-1321
Practice Address - Fax:573-472-4053
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8G392084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A11639Medicare UPIN