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General NPI Number Information
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NPI Number | 1023005097
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Entity Type | Individual
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Provider Name | MICHAEL E PETERS MD
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Gender | Male
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Dates
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Enumeration Date | 10/04/2005
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Last Update Date | 10/18/2007
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Provider Practice Location Address
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Address Line | 3360 LACROSSE LN SUITE 106
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City | NAPERVILLE
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State | IL
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Zip | 60564-8136
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Country | US
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Telephone | 630-696-4404
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Fax | 630-696-4405
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Provider Business Mailing Address
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Address Line | 3360 LACROSSE LN SUITE 106
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City | NAPERVILLE
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State | IL
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Zip | 60564-8136
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Country | US
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Telephone | 630-696-4404
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Fax | 630-696-4405
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036078421
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License Number State | IL
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