Basic Information
| Provider Information | |||||||||
| NPI: | 1104933217 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROONEY | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 777 OAKMONT LN | ||||||||
| Address2: | SUITE 1600 | ||||||||
| City: | WESTMONT | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605595511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6307892550 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9701 KNOX AVE | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | SKOKIE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600761256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476745828 | ||||||||
| FaxNumber: | 8479336044 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2006 | ||||||||
| LastUpdateDate: | 03/26/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 036056451 | IL | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 036056451 | 05 | IL | MEDICAID | P00123863 | 01 | IL | RAILROAD MEDICARE | OTHER | 3160048876 | 01 | IL | BCBS PROVIDER ID | OTHER | 340016716 | 01 | IL | RAILROAD MEDICARE | OTHER |