MEDICARE: DR. TERESITA AVILA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	036045193	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386649317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERESITA AVILA M.D.

Provider Business Mailing Address
First Line	:	3825 HIGHLAND AVE
Second Line	:	STE 2F
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-1548
Country	:	US
Telephone Number	:	630-852-3762
Fax Number	:	630-829-6818

Provider Business Practice Location Address
First Line	:	3825 HIGHLAND AVE
Second Line	:	STE 2F
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-1548
Country	:	US
Telephone Number	:	630-852-3762
Fax Number	:	630-829-6818

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	01/31/2013

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