Provider Demographics
NPI:1700057015
Name:OLIVARES, TERESA CHRISTINE (MD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:CHRISTINE
Last Name:OLIVARES
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 1:6484 COACH HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-3215
Mailing Address - Country:US
Mailing Address - Phone:630-857-3545
Mailing Address - Fax:630-857-3545
Practice Address - Street 1:15505 E 127TH ST
Practice Address - Street 2:
Practice Address - City:LEMONT
Practice Address - State:IL
Practice Address - Zip Code:60439-4433
Practice Address - Country:US
Practice Address - Phone:630-857-3545
Practice Address - Fax:630-857-3545
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036083593207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine