MEDICARE: PETER P VIENNE JR. DO

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
1	207V00000X	Obstetrics & Gynecology Physician	036082983	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	259912	OTHER	IL	HEALTH LINK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	3229984	OTHER	IL	BCBS
4	020438	OTHER	IL	HEALTH ALLIANCE

General Provider Information

NPI Number	:	1518962174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER P VIENNE JR. DO

Provider Business Mailing Address
First Line	:	1860 PAYSHERE CIRCLE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60674
Country	:	US
Telephone Number	:	630-469-9200
Fax Number	:

Provider Business Practice Location Address
First Line	:	936 W US ROUTE 6
Second Line	:
City	:	MORRIS
State	:	IL
Zip	:	60450-8858
Country	:	US
Telephone Number	:	815-942-0525
Fax Number	:	815-942-3501

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	02/02/2021

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Directions to “ PETER P VIENNE JR. DO” Practice Location

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