Healthcare Provider Details

I. General information

NPI: 1770654634
Provider Name (Legal Business Name): TERESA KAY THORPE C.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 W HIGGINS AVE
CHICAGO IL
60630-2023
US

IV. Provider business mailing address

5800 W HIGGINS AVE
CHICAGO IL
60630-2023
US

V. Phone/Fax

Practice location:
  • Phone: 773-685-4998
  • Fax: 773-685-5155
Mailing address:
  • Phone: 773-685-4998
  • Fax: 773-685-5155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License NumberCO-2809
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: