Individual provider Active NPI

Teresa Veselack, MD

  • Plastic and Reconstructive Surgery Physician
  • Chicago, IL
National Provider Identifier
1093396798
Registry record updated Jun 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X
License
125079692 Issued in IL
Practice address
1620 W Harrison St
Chicago, IL 60612-3801
Phone
(312) 942-5000
NPI assigned
Apr 15, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 13, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic and Reconstructive Surgery Physician 2086S0122X 125079692 IL Primary

Addresses

Primary practice location

1620 W Harrison St
Chicago, IL 60612-3801

Mailing address

1620 W Harrison St
Chicago, IL 60612-3801

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220817001944 IL Order and Referring Only - Plastic and Reconstructive SurgeryPractitioner - Plastic and Reconstructive Surgery 2264815620

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
125079692ILMDPlastic and Reconstructive Surgery Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1618444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655078400000",
    "number": "1093396798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1620 W HARRISON ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606123801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1620 W HARRISON ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606123801",
            "telephone_number": "312-942-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VESELACK",
        "first_name": "TERESA",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-04-15",
        "last_updated": "2022-06-13",
        "certification_date": "2022-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "IL",
            "license": "125079692",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.