MEDICARE: PETER JAMES CORMIER MD

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	2085R0202X	Diagnostic Radiology Physician	81869	WI
2	2085R0202X	Diagnostic Radiology Physician	036166224	IL
3	2085R0202X	Diagnostic Radiology Physician	4301506485	MI

General Provider Information

NPI Number	:	1942707815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER JAMES CORMIER MD

Provider Business Mailing Address
First Line	:	920 N WELLS ST APT 1511
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60610-3671
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5145 N CALIFORNIA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-3661
Country	:	US
Telephone Number	:	773-989-3814
Fax Number	:	773-989-6230

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

Provider Enumeration Date	:	04/09/2018
Last Update Date	:	05/17/2026

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