Healthcare Provider Details

I. General information

NPI: 1184782872
Provider Name (Legal Business Name): PETER D. GELDNER, M.D. S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 N LAKE SHORE DRIVE SUITE 1325
CHICAGO IL
60611
US

IV. Provider business mailing address

680 N LAKE SHORE DRIVE SUITE 1325
CHICAGO IL
60611
US

V. Phone/Fax

Practice location:
  • Phone: 312-981-4440
  • Fax: 312-981-4441
Mailing address:
  • Phone: 312-981-4440
  • Fax: 312-981-4441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number36069136
License Number StateIL

VIII. Authorized Official

Name: PETER DAVID GELDNER
Title or Position: OWNER
Credential: MD
Phone: 312-981-4440