Provider Demographics
NPI:1487623344
Name:PETER H. NEALE SC
Entity type:Organization
Organization Name:PETER H. NEALE SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:DOMBROWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-331-9400
Mailing Address - Street 1:16240 LOUIS AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473-2274
Mailing Address - Country:US
Mailing Address - Phone:708-331-9400
Mailing Address - Fax:708-331-7530
Practice Address - Street 1:16240 LOUIS AVE
Practice Address - Street 2:
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-2274
Practice Address - Country:US
Practice Address - Phone:708-331-9400
Practice Address - Fax:708-331-7530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02002162A207Q00000X
IL036-073399207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILDC7029Medicare PIN
IL209079Medicare PIN
IN221050Medicare PIN