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General NPI Number Information
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NPI Number | 1003903147
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Entity Type | Individual
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Provider Name | TERESA CRASE MD
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Gender | Female
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Dates
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Enumeration Date | 10/09/2006
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Last Update Date | 04/26/2023
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Provider Practice Location Address
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Address Line | 9880 ANGIES WAY STE. 400
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City | LOUISVILLE
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State | KY
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Zip | 40241-2851
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Country | US
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Telephone | 502-394-6500
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 776351
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City | CHICAGO
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State | IL
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Zip | 60677-6351
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Country | US
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Telephone | 502-588-9490
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD39365
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 43780
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License Number State | KY
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