Provider Demographics
NPI:1265474118
Name:LAUGHLIN, TERESE J (DPM)
Entity Type:Individual
Prefix:DR
First Name:TERESE
Middle Name:J
Last Name:LAUGHLIN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 W WALNUT ST
Mailing Address - Street 2:SUITE 12
Mailing Address - City:JACKSONVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62650-1150
Mailing Address - Country:US
Mailing Address - Phone:217-243-1101
Mailing Address - Fax:217-243-5003
Practice Address - Street 1:1515 W WALNUT ST
Practice Address - Street 2:SUITE 12
Practice Address - City:JACKSONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62650-1150
Practice Address - Country:US
Practice Address - Phone:217-243-1101
Practice Address - Fax:217-243-5003
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004832213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016004832/4974780001OtherMEDICARE DMERC
IL034378OtherHEALTH ALLIANCE
IL016004832Medicaid
IL06932011OtherBCBS OF ILLINOIS
IL330738/270056166OtherHEALTHLINK PPO
ILP00027606/DA1788OtherRAILROAD MEDICARE
ILU64408Medicare UPIN
IL016004832Medicaid