Healthcare Provider Details

I. General information

NPI: 1578679486
Provider Name (Legal Business Name): PEF CLINIC II LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 11/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2850 S WABASH AVE SUITE 203
CHICAGO IL
60616-2955
US

IV. Provider business mailing address

2850 S WABASH AVE SUITE 203
CHICAGO IL
60616-2955
US

V. Phone/Fax

Practice location:
  • Phone: 312-808-0621
  • Fax: 312-808-0655
Mailing address:
  • Phone: 312-808-0621
  • Fax: 312-808-0655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number042-617358
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number042-617358
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number042-617358
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number042-617358
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number042-617358
License Number StateIL
# 6
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number042-617358
License Number StateIL
# 7
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number042-617358
License Number StateIL

VIII. Authorized Official

Name: DR. PETER E FRIEDELL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 312-808-0621