Provider Demographics
NPI:1679547905
Name:BEISSEL, TERENCE (MD)
Entity Type:Individual
Prefix:
First Name:TERENCE
Middle Name:
Last Name:BEISSEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2160 S 1ST AVE
Mailing Address - Street 2:(16621 S. 107TH COURT, ORLAND PARK, IL. 60467)
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153
Mailing Address - Country:US
Mailing Address - Phone:708-873-7355
Mailing Address - Fax:708-460-6138
Practice Address - Street 1:2160 S 1ST AVE
Practice Address - Street 2:(16621 S. 107TH COURT, ORLAND PARK, IL. 60467)
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153
Practice Address - Country:US
Practice Address - Phone:708-873-7355
Practice Address - Fax:708-460-6138
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL36085494208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36085494Medicaid
F85272Medicare UPIN