Provider Demographics
NPI:1427217660
Name:ANTHONY P. TERRASSE M.D. S.C.
Entity Type:Organization
Organization Name:ANTHONY P. TERRASSE M.D. S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:P
Authorized Official - Last Name:TERRASSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-234-2400
Mailing Address - Street 1:700 N WESTMORELAND RD STE D
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-1672
Mailing Address - Country:US
Mailing Address - Phone:847-234-2400
Mailing Address - Fax:847-234-2470
Practice Address - Street 1:700 N WESTMORELAND RD STE D
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-1672
Practice Address - Country:US
Practice Address - Phone:847-234-2400
Practice Address - Fax:847-234-2470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036069846208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
907010Medicare PIN
E19041Medicare UPIN