Healthcare Provider Details

I. General information

NPI: 1962425132
Provider Name (Legal Business Name): JOHN JOSEPH PFEIFFER PA C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 06/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 RIDGE AVE EVANSTON HOSPITAL DEPARTMENT OF SURGERY
EVANSTON IL
60201-1718
US

IV. Provider business mailing address

2650 RIDGE AVE EVANSTON HOSPITAL DEPARTMENT OF SURGERY
EVANSTON IL
60201-1718
US

V. Phone/Fax

Practice location:
  • Phone: 847-570-2868
  • Fax: 847-733-5005
Mailing address:
  • Phone: 847-570-2868
  • Fax: 847-733-5005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number085002572
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: