Individual
DR. THERESE L POLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
807 BROADWAY ST, GILLESPIE, IL 62033-1100
(217) 839-3900
(217) 839-1313
Mailing address
807 BROADWAY ST, GILLESPIE, IL 62033-1100
(217) 839-3900
(217) 839-1313
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0005932020
BLUE CROSS BLUE SHEILD
IL
01
—
427533
HEALTHLINK
—
Enumeration date
01/16/2007
Last updated
07/08/2007
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