Healthcare Provider Details

I. General information

NPI: 1427037209
Provider Name (Legal Business Name): LORI A TEVERBAUGH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 WEST ST STE 100
PERU IL
61354-2763
US

IV. Provider business mailing address

920 WEST ST STE 100
PERU IL
61354-2763
US

V. Phone/Fax

Practice location:
  • Phone: 815-431-0435
  • Fax:
Mailing address:
  • Phone: 815-431-0435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036107129
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number036107129
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: