Healthcare Provider Details

I. General information

NPI: 1114924347
Provider Name (Legal Business Name): PETER WERNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 12/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 N RIVER RD SUITE 210
DES PLAINES IL
60016-1272
US

IV. Provider business mailing address

7607 MADISON ST
FOREST PARK IL
60130-3513
US

V. Phone/Fax

Practice location:
  • Phone: 847-759-4060
  • Fax: 847-759-4066
Mailing address:
  • Phone: 708-366-7177
  • Fax: 708-366-3301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number036046395
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: