Individual
TERESA E DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2875 W 19TH ST, CHICAGO, IL 60623-3501
(773) 484-4831
(773) 484-4829
Mailing address
9437 S. BELL AVE., CHICAGO, IL 60643
(773) 238-5471
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
036114569
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036114569
—
IL
05
—
036114569-2
—
IL
Enumeration date
09/22/2006
Last updated
08/13/2009
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