Individual
DR. M. TERESA C. FRASER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1701 W. GARDEN STREET, PEORIA, IL 61605-3531
(309) 680-7600
(309) 680-7637
Mailing address
1701 W. GARDEN STREET, HEARTLAND COMMUNITY HEALTH CLINIC, PEORIA, IL 61605-3531
(309) 680-7600
(309) 676-5506
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
036-088897
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036088897
—
IL
01
—
809840
MEDICARE GROUP #
IL
Enumeration date
05/08/2007
Last updated
08/09/2010
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