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General NPI Number Information
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NPI Number | 1558390849
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Entity Type | Organization
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Legal Business Name | PEAK THERAPEUTICS, LTD
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Dates
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Enumeration Date | 07/01/2006
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Last Update Date | 02/20/2013
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Provider Practice Location Address
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Address Line | 3545 LAKE AVE SUITE 103
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City | WILMETTE
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State | IL
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Zip | 60091-1058
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Country | US
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Telephone | 847-906-2025
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Fax | 847-512-5064
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Provider Business Mailing Address
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Address Line | 3545 LAKE AVE SUITE 103
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City | WILMETTE
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State | IL
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Zip | 60091-1058
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Country | US
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Telephone | 847-906-2025
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Fax | 847-512-5064
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JAMES KEVIN BUSKIRK
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Credential | P.T.
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Telephone | 847-906-2025
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 060004284
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License Number State | IL
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