Provider Demographics
NPI:1437174299
Name:HASKINS, TERESA (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:
Last Name:HASKINS
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3473 S KING DR
Mailing Address - Street 2:STE # 511
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-4108
Mailing Address - Country:US
Mailing Address - Phone:888-205-0893
Mailing Address - Fax:888-205-0893
Practice Address - Street 1:3473 S KING DR
Practice Address - Street 2:STE # 511
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-4108
Practice Address - Country:US
Practice Address - Phone:888-205-0893
Practice Address - Fax:888-205-0893
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN345012083X0100X
IA357152083X0100X
LA15233R2083X0100X
IL036-1166372083X0100X
IN01062574A2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H97902Medicare UPIN