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General NPI Number Information
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NPI Number | 1154647550
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Entity Type | Individual
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Provider Name | MATTHIAS PEUSTER M.D., PHD
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Gender | Male
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Dates
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Enumeration Date | 04/12/2010
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Last Update Date | 03/11/2013
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Provider Practice Location Address
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Address Line | 5841 S MARYLAND AVE K355, MC 4051
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City | CHICAGO
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State | IL
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Zip | 60637-1447
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Country | US
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Telephone | 773-705-4475
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Fax | 773-834-3795
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Provider Business Mailing Address
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Address Line | 5535 S BLACKSTONE AVE
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City | CHICAGO
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State | IL
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Zip | 60637-1833
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Country | US
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Telephone | 773-702-1022
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Fax | 773-834-3795
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 113000057
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number | 113000057
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License Number State | IL
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