Healthcare Provider Details

I. General information

NPI: 1477544302
Provider Name (Legal Business Name): ANTHONY PAUL TERRASSE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 12/10/2021
Certification Date: 12/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 N WESTMORELAND RD BUILDING D
LAKE FOREST IL
60045-1679
US

IV. Provider business mailing address

700 NORTH WESTMORELAND ROAD BUILDING D
LAKE FOREST IL
60045
US

V. Phone/Fax

Practice location:
  • Phone: 847-234-2400
  • Fax: 847-234-2470
Mailing address:
  • Phone: 847-234-2400
  • Fax: 847-234-2470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number036-069846
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: