Healthcare Provider Details

I. General information

NPI: 1255300042
Provider Name (Legal Business Name): TE SHAO HSU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 10/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 E DEVON AVE STE 200
ITASCA IL
60143-2639
US

IV. Provider business mailing address

1860 PAYSPHERE CIR
CHICAGO IL
60674-0018
US

V. Phone/Fax

Practice location:
  • Phone: 864-625-3376
  • Fax: 855-792-2250
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number036118825
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: