Organization Name: | C.G.PETERS LLC |
NPI Number: | 1215021647 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CONSTANTINE G PETERS (OWNER) |
Mailing Address: | 13305 S Ridgeland Ave Unit B Palos Heights |
State: | IL US |
Postal Code: | 604631808 |
Phone Number: | 7083899226 |
Fax Number: | 7083892004 |
NPI Enumeration Date: | 10/02/2006 |
NPI Last Update Date: | 04/04/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 036107020 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |