Healthcare Provider Details

I. General information

NPI: 1538614227
Provider Name (Legal Business Name): PETER CUI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2016
Last Update Date: 08/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2065 HALF DAY RD
BANNOCKBURN IL
60015-1241
US

IV. Provider business mailing address

10289 E 34 RD
CADILLAC MI
49601-9581
US

V. Phone/Fax

Practice location:
  • Phone: 847-945-8800
  • Fax:
Mailing address:
  • Phone: 217-313-5244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: