MEDICARE: DR. TERESA HASKINS M.D., MPH

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	2083X0100X	Occupational Medicine Physician	34501	TN
2	2083X0100X	Occupational Medicine Physician	35715	IA
3	2083X0100X	Occupational Medicine Physician	15233R	LA
4	2083X0100X	Occupational Medicine Physician	036-116637	IL
5	2083X0100X	Occupational Medicine Physician	01062574A	IN

General Provider Information

NPI Number	:	1437174299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERESA HASKINS M.D., MPH

Provider Business Mailing Address
First Line	:	3473 S KING DR
Second Line	:	STE # 511
City	:	CHICAGO
State	:	IL
Zip	:	60616-4108
Country	:	US
Telephone Number	:	888-205-0893
Fax Number	:	888-205-0893

Provider Business Practice Location Address
First Line	:	3473 S KING DR
Second Line	:	STE # 511
City	:	CHICAGO
State	:	IL
Zip	:	60616-4108
Country	:	US
Telephone Number	:	888-205-0893
Fax Number	:	888-205-0893

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

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	01/21/2016

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