Healthcare Provider Details

I. General information

NPI: 1417266883
Provider Name (Legal Business Name): BRIAN RAMON PEETE M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2010
Last Update Date: 10/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5341 W CERMAK RD
CICERO IL
60804-2817
US

IV. Provider business mailing address

10626 S LEAVITT ST
CHICAGO IL
60643-3130
US

V. Phone/Fax

Practice location:
  • Phone: 708-656-6430
  • Fax:
Mailing address:
  • Phone: 312-480-9841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: