Individual
TERRY LIGHT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2160 S FIRST AVE, 101-1740, LOYOLA UNIVERSITY MEDICAL CENTER, MAYWOOD, IL 60153
(708) 216-4570
(708) 216-5858
Mailing address
2160 S FIRST AVE, 101-1740, LOYOLA UNIVERSITY MEDICAL CENTER, MAYWOOD, IL 60153
(708) 216-4570
(708) 216-5858
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
036060621
IL
207XS0106X
Orthopaedic Hand Surgery Physician
Primary
36060621
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36060621
—
IL
Enumeration date
02/14/2006
Last updated
08/24/2018
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