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NPI Code Detail

MEDICARE: PENG JI M.D., PH.D.

MEDICARE: PENG JI M.D., PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207ZC0006XClinical Pathology Physician125-058983IL

General Provider Information

NPI Number : 1154639771
Entity Type Code : Individual
Provider Name (Legal Business Name) : PENG JI M.D., PH.D.
Provider Business Mailing Address
First Line : 303 E CHICAGO AVE
Second Line : WARD 3-140
City : CHICAGO
State : IL
Zip : 60611-4296
Country : US
Telephone Number : 617-901-5198
Fax Number :
Provider Business Practice Location Address
First Line : 420 E SUPERIOR ST
Second Line : RUBLOFF BUILDING 12-172
City : CHICAGO
State : IL
Zip : 60611-4494
Country : US
Telephone Number : 312-503-4756
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/16/2010
Last Update Date : 02/01/2017

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