Healthcare Provider Details

I. General information

NPI: 1447698691
Provider Name (Legal Business Name): UCHENNA PELZER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2013
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E CHICAGO AVE
CHICAGO IL
60611-2991
US

IV. Provider business mailing address

158 CIRCLE RIDGE DR
BURR RIDGE IL
60527-8379
US

V. Phone/Fax

Practice location:
  • Phone: 773-702-5444
  • Fax:
Mailing address:
  • Phone: 770-354-5199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125063202
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: