Healthcare Provider Details

I. General information

NPI: 1942423587
Provider Name (Legal Business Name): PETER R. LEWY, MD, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 CENTRAL AVE SUITE H
WILMETTE IL
60091-2666
US

IV. Provider business mailing address

1100 CENTRAL AVE SUITE H
WILMETTE IL
60091-2666
US

V. Phone/Fax

Practice location:
  • Phone: 847-256-6480
  • Fax: 847-256-6482
Mailing address:
  • Phone: 847-256-6480
  • Fax: 847-256-6482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number042004736
License Number StateIL

VIII. Authorized Official

Name: DR. PETER R LEWY
Title or Position: OWNER
Credential: M.D.
Phone: 847-256-6480