Provider Demographics
NPI:1639274624
Name:TERRADO, LOURDES R (MD)
Entity type:Individual
Prefix:
First Name:LOURDES
Middle Name:R
Last Name:TERRADO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19550 GOVERNORS HWY
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422-2125
Mailing Address - Country:US
Mailing Address - Phone:708-957-8750
Mailing Address - Fax:708-957-8602
Practice Address - Street 1:19550 GOVERNORS HWY
Practice Address - Street 2:SUITE 2000
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-2125
Practice Address - Country:US
Practice Address - Phone:708-957-8750
Practice Address - Fax:708-957-8602
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL390008309/CA4448OtherRAILROAD PALMETTO GBA
IL4673170001OtherDMERC
ILP00439438/CK6882OtherRAILROAD PALMETTO GBA
ILK23152Medicare ID - Type Unspecified
ILP00439438/CK6882OtherRAILROAD PALMETTO GBA
ILK46758/203980Medicare PIN
IL390008309/CA4448OtherRAILROAD PALMETTO GBA