Healthcare Provider Details

I. General information

NPI: 1356045868
Provider Name (Legal Business Name): BENJAMIN OBADIAH PETERS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2023
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4220 W 95TH ST
OAK LAWN IL
60453-2793
US

IV. Provider business mailing address

8915 W CONNELL AVE
MILWAUKEE WI
53226-3067
US

V. Phone/Fax

Practice location:
  • Phone: 312-949-4200
  • Fax: 708-423-1899
Mailing address:
  • Phone: 414-266-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number8211821
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125.081586
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: