Healthcare Provider Details

I. General information

NPI: 1902814502
Provider Name (Legal Business Name): THEODORE TOERNE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 05/02/2024
Certification Date: 05/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 W 95TH ST DEPARTMENT OF EMERGENCY MEDICINE
OAK LAWN IL
60453-2600
US

IV. Provider business mailing address

66 W 15TH ST
CHICAGO IL
60605-2727
US

V. Phone/Fax

Practice location:
  • Phone: 708-684-5354
  • Fax: 708-684-1028
Mailing address:
  • Phone: 312-922-1553
  • Fax: 312-922-1553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2282-320
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207PT0002X
TaxonomyMedical Toxicology (Emergency Medicine) Physician
License Number360940030
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number360940030
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: