Tessalee, Daphne

Tessalee, Daphne is an individual health care provider with primary practice located at 1325 Community Memorial Dr , La Grange IL 60525-2659. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Tessalee, Daphne can be contacted via phone (708) 245-8900.

Contact Information

Primary practice address
1325 Community Memorial Dr La Grange IL 60525-2659
Phone: (708) 245-8900
Fax: (708) 245-5604
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 36094766 Illinois

Profile Details

NPI number 1124078357
LBN Legal business name Tessalee, Daphne
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 10th, 2006
Last updated Mar 24th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1124078357 NPPES
Illinois MEDICAID 036094766

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