Provider Demographics
NPI:1073575692
Name:HUANG, TERESITA HERNANDEZ (MD)
Entity Type:Individual
Prefix:DR
First Name:TERESITA
Middle Name:HERNANDEZ
Last Name:HUANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:TERESITA
Other - Middle Name:HERNANDEZ
Other - Last Name:HUANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3450 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-1062
Mailing Address - Country:US
Mailing Address - Phone:847-251-6276
Mailing Address - Fax:
Practice Address - Street 1:3450 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-1062
Practice Address - Country:US
Practice Address - Phone:847-251-6276
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider