Provider Demographics
NPI:1164674131
Name:GANDOR, THERESA CATHERINE (MD)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:CATHERINE
Last Name:GANDOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:800 W CENTRAL RD
Mailing Address - Street 2:NORTHWEST COMMUNITY HOSPITAL - EMERGENCY DEPT.
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-2349
Mailing Address - Country:US
Mailing Address - Phone:847-618-3040
Mailing Address - Fax:847-618-3049
Practice Address - Street 1:800 W CENTRAL RD
Practice Address - Street 2:NORTHWEST COMMUNITY HOSPITAL - EMERGENCY DEPT.
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-2349
Practice Address - Country:US
Practice Address - Phone:847-618-3040
Practice Address - Fax:847-618-3049
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036121957207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036121957Other036121957 - IL STATE PERMANENT PHYSICIAN LICENSE NUMBER