Healthcare Provider Details

I. General information

NPI: 1487699880
Provider Name (Legal Business Name): LOUIS TEODORI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: LOUIS THOMPSON

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 10/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 E 86TH AVEUNE SUITE Z
MERRILLVILLE IN
46410
US

IV. Provider business mailing address

521 E 86TH AVE SUITE Z
MERRILLVILLE IN
46410-6173
US

V. Phone/Fax

Practice location:
  • Phone: 219-769-0777
  • Fax: 219-755-0610
Mailing address:
  • Phone: 219-769-0777
  • Fax: 219-755-0610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number02002924
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: