Basic Information
| Provider Information | |||||||||
| NPI: | 1306233945 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KUSPER | ||||||||
| FirstName: | TERESA | ||||||||
| MiddleName: | MARIA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10248 SOUTHWEST HWY APT 3D | ||||||||
| Address2: | |||||||||
| City: | CHICAGO RIDGE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604151442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7085399939 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1200 S YORK ST | ||||||||
| Address2: | |||||||||
| City: | ELMHURST | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601265626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3312211000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2015 | ||||||||
| LastUpdateDate: | 08/13/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 036.149764 | IL | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.