Provider Demographics
NPI:1477544302
Name:TERRASSE, ANTHONY PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:PAUL
Last Name:TERRASSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:700 NORTH WESTMORELAND ROAD
Mailing Address - Street 2:BUILDING D
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045
Mailing Address - Country:US
Mailing Address - Phone:847-234-2400
Mailing Address - Fax:847-234-2470
Practice Address - Street 1:700 N WESTMORELAND RD
Practice Address - Street 2:BUILDING D
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-1679
Practice Address - Country:US
Practice Address - Phone:847-234-2400
Practice Address - Fax:847-234-2470
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-069846208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
E19041Medicare UPIN
907010Medicare ID - Type Unspecified