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General NPI Number Information
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NPI Number | 1184782872
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Entity Type | Organization
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Legal Business Name | PETER D. GELDNER, M.D. S.C.
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 06/19/2008
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Provider Practice Location Address
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Address Line | 680 N LAKE SHORE DRIVE SUITE 1325
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City | CHICAGO
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State | IL
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Zip | 60611
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Country | US
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Telephone | 312-981-4440
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Fax | 312-981-4441
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Provider Business Mailing Address
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Address Line | 680 N LAKE SHORE DRIVE SUITE 1325
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City | CHICAGO
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State | IL
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Zip | 60611
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Country | US
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Telephone | 312-981-4440
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Fax | 312-981-4441
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Authorized Official
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Title or Position | OWNER
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Name | PETER DAVID GELDNER
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Credential | MD
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Telephone | 312-981-4440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 36069136
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License Number State | IL
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