DR. TESFU HAILU (NPI# 1245490382) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1245490382 |
| Entity Type | Individual |
| Full Name | DR. TESFU HAILU |
| Credential | MD |
| Practice Address |
4909 N Glen Park Place Rd Peoria IL 61614-4676 |
| Mailing Address |
4909 N Glen Park Place Rd Peoria IL 61614-4689 |
| Practice Telephone | 3096747546 |
| Practice Fax Number | 3096919286 |
| Mailing Telephone | 3096747546 |
| Mailing Fax Number | 3092822075 |
| Enumeration Date | 2008-06-12 |
| Last Update Date | 2020-05-11 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207ND0900X |
Dermatology Specialization: Dermatopathology |
036151973 | IL | Allopathic & Osteopathic Physicians |
| Street Address |
4909 N GLEN PARK PLACE RD |
| City | PEORIA |
| State | IL |
| Zip Code | 61614-4676 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174599260 | Chen Wang | Pathology | 4909 N Glen Park Place Rd, Peoria, IL 61614-4676 | 2006-02-27 |
| 1790180164 | Sara Snarr | Nurse Practitioner | 4909 N Glen Park Place Rd, Peoria, IL 61614-4676 | 2014-10-28 |
| 1700209160 | Sarah Christensen | Physician Assistant | 4909 N Glen Park Place Rd, Peoria, IL 61614-4676 | 2014-01-21 |
| 1134481054 | Nour Almardini | Pathology | 4909 N Glen Park Place Rd, Peoria, IL 61614-4689 | 2012-06-15 |
| 1922313238 | Stephanie M Ellis | Physician Assistant | 4909 N Glen Park Place Rd, Peoria, IL 61614-4676 | 2010-08-11 |
| 1477743813 | Michelle L Roth | Physician Assistant | 4909 N Glen Park Place Rd, Peoria, IL 61614-4676 | 2007-08-01 |
| 1073655676 | James Murray Jeffries IIi | Surgery | 4909 N Glen Park Place Rd, Peoria, IL 61614-4676 | 2007-02-12 |
| 1912017245 | Michael L Hayes | Dermatology | 4909 N Glen Park Place Rd, Peoria, IL 61614-4676 | 2006-08-30 |
| 1871506931 | John R Soderstrom | Physician Assistant | 4909 N Glen Park Place Rd, Peoria, IL 61614-4676 | 2006-08-13 |
| 1710931670 | Soderstrom Dermatology Center S C | Pathology | 4909 N Glen Park Place Rd, Peoria, IL 61614-4676 | 2006-05-22 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548818511 | Christine Svoboda | Social Worker | 6919 N Knoxville Ave Ste 100 and 202, Peoria, IL 61614 | 2019-09-03 |
| 1639649007 | Kathy Karouzos Counseling, LLC | Clinic/Center | 330 W. Ivy Ln., Peoria, IL 61614 | 2018-11-28 |
| 1205312790 | Kathleen Marie Hendricks | Nurse Practitioner | 2809 W Willow Knolls Dr, Peoria, IL 61614 | 2018-07-17 |
| 1629563937 | Mary Elizabeth Cunningham | Counselor | 6219 N. Eldorado Dr., Peoria, IL 61614 | 2018-06-28 |
| 1861937955 | Angela Gilles | Social Worker | 6919 N Knoxville Ave Ste 100, Peoria, IL 61614 | 2016-12-27 |
| 1467994897 | Melissa Saxsma | Specialist | 5009 N Executive Dr, Peoria, IL 61614 | 2016-11-16 |
| 1902258874 | Rashid Plastic Surgery, LLC | Plastic Surgery | 804 W Trailcreek Drive, Peoria, IL 61614 | 2016-07-05 |
| 1215313143 | Melissa Lynn Phelan | Nurse Practitioner | 122 E Morningside Dr, Peoria, IL 61614 | 2015-08-03 |
| 1811380165 | All Ways Caring Services, Inc. | In Home Supportive Care | 6919 N Knoxville Ave, Suite 102, Peoria, IL 61614 | 2015-03-11 |
| 1568875920 | Schuler & Arkwell Orthodontic Partnership | Dentist | 2425 Cornerstone Ct. Ste. A, Peoria, IL 61614 | 2014-06-03 |
| Find all providers in zip 61614 | ||||
| Taxonomy Code | 207ND0900X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| Specialization | Dermatopathology |
| A dermatopathologist has the expertise to diagnose and monitor diseases of the skin including infectious, immunologic, degenerative and neoplastic diseases. This entails the examination and interpretation of specially prepared tissue sections, cellular scrapings and smears of skin lesions by means of routine and special (electron and fluorescent) microscopes. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/; American Osteopathic Board of Dermatology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Dermatology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376866897 | Physicians Dermpath Laboratory | Dermatology | 1420 N. Renaissance Dr., Suite 204, Park Ridge, IL 60068-1330 | 2010-03-11 |
| 1417075961 | Asanee Lertsburapa | Dermatology | 708 Midwest Club Park Parkway, Oak Brook, IL 60523 | 2007-03-26 |
| 1861404279 | Nathaniel Morgan | Dermatology | 11157 S Halsted St, Chicago, IL 60628-3910 | 2006-08-13 |
| 1467476457 | Jeffrey Berti | Dermatology | 6825 Kingery Hwy, Willowbrook, IL 60527-5154 | 2006-07-26 |
| 1023040573 | Thomas L. Fisher, M.d., S.c. | Dermatology | 47 W Polk St Lbby G1, Chicago, IL 60605-2087 | 2006-07-07 |
| 1215902986 | George T Nahass | Dermatology | 4107 S Water Tower Pl, Mount Vernon, IL 62864-6293 | 2006-02-17 |
| 1467955179 | United Skin Specialists Illinois Ltd, PC | Dermatology | 4107 S Water Tower Pl, Mount Vernon, IL 62864-6293 | 2018-03-09 |
| 1194225268 | United Skin Specialists Illinois Ltd, PC | Dermatology | 4107 S Water Tower Pl, Mount Vernon, IL 62864-6293 | 2018-02-15 |
| 1073041455 | Sepideh Asadbeigi | Dermatology | 676 N Saint Clair St Ste 1600, Chicago, IL 60611-2997 | 2017-05-30 |
| 1548517949 | Michael Sidiropoulos | Dermatology | 676 N Saint Clair St Ste 1600, Chicago, IL 60611-2997 | 2012-08-06 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.