Provider Demographics
NPI:1770654634
Name:THORPE, TERESA KAY (CO)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:KAY
Last Name:THORPE
Suffix:
Gender:F
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 W HIGGINS AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-2023
Mailing Address - Country:US
Mailing Address - Phone:773-685-4998
Mailing Address - Fax:773-685-5155
Practice Address - Street 1:5800 W HIGGINS AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-2023
Practice Address - Country:US
Practice Address - Phone:773-685-4998
Practice Address - Fax:773-685-5155
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILCO-2809247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4317310001Medicare ID - Type Unspecified