Basic Information
Provider Information
NPI: 1659372266
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PETERS
FirstName: JOHN
MiddleName: R.
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 520 E 22ND ST
Address2:  
City: LOMBARD
State: IL
PostalCode: 601486110
CountryCode: US
TelephoneNumber: 6308742542
FaxNumber: 6308742642
Practice Location
Address1: 800 W CENTRAL RD
Address2:  
City: ARLINGTON HEIGHTS
State: IL
PostalCode: 600052349
CountryCode: US
TelephoneNumber: 8476181000
FaxNumber: 8476187169
Other Information
ProviderEnumerationDate: 08/04/2005
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208600000X ILY Allopathic & Osteopathic PhysiciansSurgery 

No ID Information.


Home