Individual provider Active NPI

Grzegorz W Telega, MD

  • Pediatric Gastroenterology Physician
  • Milwaukee, WI
National Provider Identifier
1356392005
Registry record updated Nov 25, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Gastroenterology PhysicianTaxonomy code 2080P0206X
License
42281 Issued in WI
Practice address
9000 W Wisconsin Ave
Pediatric Gastroenterology
Milwaukee, WI 53226-4874
Phone
(414) 266-3690
Fax
(414) 266-3676
NPI assigned
May 15, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Gastroenterology Physician 2080P0206X 42281 WI Primary

Addresses

Primary practice location

9000 W Wisconsin Ave
Pediatric Gastroenterology
Milwaukee, WI 53226-4874

Mailing address

9000 W Wisconsin Ave
Pediatric Gastroenterology
Milwaukee, WI 53226-4874
Phone (414) 266-3690

Other identifiers 2

IdentifierTypeStateIssuer
002006261DOtherHUMANA
1356392005MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050727000324 WI Practitioner - GastroenterologyPractitioner - Pediatric Medicine 2466480900 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
42281WIMDPediatric Gastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Children'S Specialty Group, Inc. CurrentSince May 25, 2024 Accepting new patients
The Medical College of Wisconsin, Inc. CurrentSince Mar 18, 2011 Accepting new patients

Locations

10911 N Port Washington Rd
Mequon, WI 53092
Phone (262) 241-2080

Bin 88350
Milwaukee, WI 53288
Phone (414) 805-3122

1320 Wisconsin Ave
Racine, WI 53403
Phone (262) 687-2222

1601 N Taylor Dr
Sheboygan, WI 53081
Phone (920) 459-4767

8701 Watertown Plank Rd
Wauwatosa, WI 53226
Phone (414) 456-4100

9000 W Wisconsin Ave
Wauwatosa, WI 53226
Phone (414) 266-2625

Interoperability endpoints

  • Direct secure messaging: gtelega6120@direct.chw.org

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1385337600000",
    "number": "1356392005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9000 W WISCONSIN AVE",
            "address_2": "PEDIATRIC GASTROENTEROLOGY",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532264874",
            "telephone_number": "414-266-3690",
            "fax_number": "414-266-3676"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9000 W WISCONSIN AVE",
            "address_2": "PEDIATRIC GASTROENTEROLOGY",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532264874",
            "telephone_number": "414-266-3690",
            "fax_number": "414-266-3676"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TELEGA",
        "first_name": "GRZEGORZ",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-15",
        "last_updated": "2013-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "WI",
            "license": "42281",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA",
            "identifier": "002006261D",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1356392005",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.