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General NPI Number Information
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NPI Number | 1487651550
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Entity Type | Individual
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Provider Name | KENNETH M PELEHAC DO
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Gender | Male
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Dates
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Enumeration Date | 07/05/2005
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Last Update Date | 06/18/2018
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Provider Practice Location Address
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Address Line | 5404 FOXWOODS DR
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City | OAK LAWN
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State | IL
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Zip | 60453
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Country | US
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Telephone | 708-382-1615
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Fax | 888-702-1052
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Provider Business Mailing Address
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Address Line | 5404 FOXWOODS DR
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City | OAK LAWN
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State | IL
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Zip | 60453-5073
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Country | US
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Telephone | 708-382-1615
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Fax | 888-702-1052
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 036085109
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 2086S0102X
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Taxonomy Name | Surgical Critical Care Physician
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License Number | 036085109
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 49770
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License Number State | WI
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