Healthcare Provider Details

I. General information

NPI: 1972505741
Provider Name (Legal Business Name): ROBERT L. PEISS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 09/22/2023
Certification Date: 09/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BERTEAU AVE ELMHURST MEMORIAL HOSPITAL / RADIOLOGY DEPARTMENT
ELMHURST IL
60126-2966
US

IV. Provider business mailing address

520 E 22ND ST
LOMBARD IL
60148-6110
US

V. Phone/Fax

Practice location:
  • Phone: 630-941-4561
  • Fax: 630-941-4590
Mailing address:
  • Phone: 630-874-2542
  • Fax: 630-874-2642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License NumberMD460701
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number036066629
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: