Provider Demographics
NPI:1639138324
Name:TORRES, TERESITA (MD)
Entity Type:Individual
Prefix:DR
First Name:TERESITA
Middle Name:
Last Name:TORRES
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 1:200 LAIRD LN
Mailing Address - Street 2:
Mailing Address - City:WATSEKA
Mailing Address - State:IL
Mailing Address - Zip Code:60970-7568
Mailing Address - Country:US
Mailing Address - Phone:815-432-5411
Mailing Address - Fax:815-432-3955
Practice Address - Street 1:200 LAIRD LN
Practice Address - Street 2:
Practice Address - City:WATSEKA
Practice Address - State:IL
Practice Address - Zip Code:60970-7568
Practice Address - Country:US
Practice Address - Phone:815-432-5411
Practice Address - Fax:815-432-3955
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036085512207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200126850AMedicaid
K10958OtherPIN
IL0360855121Medicaid
IL03815080OtherBCBS
IL3711693620021Medicaid
K10958OtherPIN
F50865Medicare UPIN
IL03815080OtherBCBS
GACB9043Medicare ID - Type UnspecifiedTRAVELERS