Individual
MR. NOEL C TEODORO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RSA
Contact information
Practice address
333 MADISON ST, JOLIET, IL 60435-8200
(815) 725-7133
Mailing address
16525 W 159TH ST # 140, LOCKPORT, IL 60441-7900
(708) 602-2183
(815) 600-8637
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
238.000243
IL
246ZC0007X
Surgical Assistant
238000243
IL
363AS0400X
Surgical Physician Assistant
238.000243
IL
Other
Enumeration date
12/14/2009
Last updated
03/11/2020
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