Provider Demographics
NPI:1174728638
Name:DR. FLORENCE L. PETERS, DPM, LLC
Entity type:Organization
Organization Name:DR. FLORENCE L. PETERS, DPM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FLORENCE
Authorized Official - Middle Name:LEAH
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:630-329-9758
Mailing Address - Street 1:1330 SUNNYSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-2840
Mailing Address - Country:US
Mailing Address - Phone:630-329-9758
Mailing Address - Fax:
Practice Address - Street 1:4921 W ELM ST
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-4020
Practice Address - Country:US
Practice Address - Phone:630-329-9758
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT35534Medicare UPIN