Provider Demographics
NPI:1457375115
Name:DALLAS-PRUNSKIS, TERRI L (MD)
Entity Type:Individual
Prefix:DR
First Name:TERRI
Middle Name:L
Last Name:DALLAS-PRUNSKIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:431 SUMMIT
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60120
Mailing Address - Country:US
Mailing Address - Phone:847-289-8822
Mailing Address - Fax:847-289-0815
Practice Address - Street 1:4309 MEDICAL CENTER DR
Practice Address - Street 2:B103
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050
Practice Address - Country:US
Practice Address - Phone:815-363-9595
Practice Address - Fax:815-578-4530
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036073541208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C39132Medicare UPIN