=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194020123
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TERRILYNN WOOD M.ED
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2011
-----------------------------------------------------
Last Update Date | 01/23/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3651 W 85TH ST
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60652-3701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-991-9879
-----------------------------------------------------
Fax | 773-789-2241
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3651 W 85TH ST
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60652-3701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-991-9879
-----------------------------------------------------
Fax | 773-789-2241
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------