Healthcare Provider Details

I. General information

NPI: 1104137082
Provider Name (Legal Business Name): PETER HURH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2010
Last Update Date: 04/16/2020
Certification Date: 04/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 S DAMEN AVE RM 2514
CHICAGO IL
60612
US

IV. Provider business mailing address

820 S DAMEN AVE RM 2514
CHICAGO IL
60612-3728
US

V. Phone/Fax

Practice location:
  • Phone: 312-569-6376
  • Fax: 312-569-8050
Mailing address:
  • Phone: 312-569-6376
  • Fax: 312-569-8050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number125058243
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number036-147909
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: