Provider Demographics
NPI:1487851184
Name:ASAM-JENSEN, TERESA (MD)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:ASAM-JENSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1645 S RIVER RD STE 2
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60018-2206
Mailing Address - Country:US
Mailing Address - Phone:224-803-2273
Mailing Address - Fax:224-803-2274
Practice Address - Street 1:1645 S RIVER RD STE 2
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60018-2206
Practice Address - Country:US
Practice Address - Phone:224-803-2273
Practice Address - Fax:224-803-2274
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.125741208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatrics