Provider Demographics
NPI:1144253873
Name:HANUSA, TERRY LOUIS (MD)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:LOUIS
Last Name:HANUSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1500 WAUKEGAN RD
Mailing Address - Street 2:SUITE 213
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-2100
Mailing Address - Country:US
Mailing Address - Phone:847-998-5556
Mailing Address - Fax:847-998-9156
Practice Address - Street 1:1500 WAUKEGAN RD
Practice Address - Street 2:SUITE 213
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-2100
Practice Address - Country:US
Practice Address - Phone:847-998-5556
Practice Address - Fax:847-998-9156
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360653812084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
D15303Medicare UPIN
IL717760Medicare ID - Type Unspecified