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General NPI Number Information
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NPI Number | 1477544302
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Entity Type | Individual
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Provider Name | ANTHONY PAUL TERRASSE M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/31/2005
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Last Update Date | 12/10/2021
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Provider Practice Location Address
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Address Line | 700 N WESTMORELAND RD BUILDING D
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City | LAKE FOREST
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State | IL
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Zip | 60045-1679
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Country | US
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Telephone | 847-234-2400
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Fax | 847-234-2470
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Provider Business Mailing Address
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Address Line | 700 NORTH WESTMORELAND ROAD BUILDING D
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City | LAKE FOREST
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State | IL
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Zip | 60045
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Country | US
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Telephone | 847-234-2400
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Fax | 847-234-2470
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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 | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 036-069846
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License Number State | IL
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