Healthcare Provider Details

I. General information

NPI: 1790780765
Provider Name (Legal Business Name): MARVIN S PEIKEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 02/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5999 NEW WILKE RD SUITE 200 BLDG 2
ROLLING MEADOWS IL
60008-4506
US

IV. Provider business mailing address

5999 NEW WILKE RD SUITE 200 BLDG 2
ROLLING MEADOWS IL
60008-4506
US

V. Phone/Fax

Practice location:
  • Phone: 847-255-7107
  • Fax: 847-255-7031
Mailing address:
  • Phone: 847-255-7107
  • Fax: 847-255-7031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036053584
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: