Healthcare Provider Details

I. General information

NPI: 1235156266
Provider Name (Legal Business Name): VICTOR MANUEL PELAEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 04/28/2021
Certification Date: 04/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 W HARRISON ST JOHN H STROGER ,JR. HOSPITAL OF COKK COUNTY
CHICAGO IL
60612-3714
US

IV. Provider business mailing address

903 S ASHLAND AVE APT 101
CHICAGO IL
60607-4002
US

V. Phone/Fax

Practice location:
  • Phone: 312-864-6000
  • Fax:
Mailing address:
  • Phone: 312-850-1817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number36106330
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number036-106330
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: