Basic Information
| Provider Information | |||||||||
| NPI: | 1922184035 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCCARTHY | ||||||||
| FirstName: | TERESA | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | UNIVERSITY OF MINNESOTA PHYSICIANS | ||||||||
| Address2: | SMILEY'S CLINIC, 2615 EAST FRANKLIN AVE | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6123330770 | ||||||||
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| Practice Location | |||||||||
| Address1: | UNIVERSITY OF MINNESOTA PHYSICIANS | ||||||||
| Address2: | SMILEY'S CLINIC, 2615 EAST FRANKLIN AVE | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6123330770 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2006 | ||||||||
| LastUpdateDate: | 02/15/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 32692 | MN | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207R00000X | 32692 | MN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0300X | 32692 | MN | N | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 04-02572 | 01 | MEDICA CHOICE | OTHER | 1017485 | 01 | PREFERRED ONE | OTHER | 1543785 | 05 | IA | MEDICAID | 766124 | 01 | ARAZ | OTHER | 41G08MC | 01 | BLUE CROSS BLUE SHIELD | OTHER | HP21054 | 01 | HEALTH PARTNERS | OTHER | 04-02572 | 01 | MEDICA PRIMARY | OTHER | 091797400 | 05 | MN | MEDICAID | 101484 | 01 | UCARE | OTHER |