Provider Demographics
NPI:1487699880
Name:TEODORI, LOUIS (DO)
Entity type:Individual
Prefix:
First Name:LOUIS
Middle Name:
Last Name:TEODORI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:LOUIS
Other - Middle Name:
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:521 E 86TH AVE
Mailing Address - Street 2:SUITE Z
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-6173
Mailing Address - Country:US
Mailing Address - Phone:219-769-0777
Mailing Address - Fax:219-755-0610
Practice Address - Street 1:521 E 86TH AVEUNE
Practice Address - Street 2:SUITE Z
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410
Practice Address - Country:US
Practice Address - Phone:219-769-0777
Practice Address - Fax:219-755-0610
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN020029242084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
INI48998Medicare UPIN