Healthcare Provider Details

I. General information

NPI: 1205910114
Provider Name (Legal Business Name): TERRILL APPLEWHITE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 BROWN BLVD STE 103
BOURBONNAIS IL
60914-2325
US

IV. Provider business mailing address

475 BROWN BLVD STE 103
BOURBONNAIS IL
60914-2325
US

V. Phone/Fax

Practice location:
  • Phone: 815-937-7962
  • Fax: 815-936-8650
Mailing address:
  • Phone: 815-937-7962
  • Fax: 815-936-8650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036104924
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: