=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881882868
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PETER E EUPIERRE M.D P.C
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2007
-----------------------------------------------------
Last Update Date | 06/12/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1111 SUPERIOR ST SUITE 408
-----------------------------------------------------
City | MELROSE PARK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60160-4158
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-345-2035
-----------------------------------------------------
Fax | 708-345-2040
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1111 SUPERIOR ST SUITE 408
-----------------------------------------------------
City | MELROSE PARK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60160-4158
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-345-2035
-----------------------------------------------------
Fax | 708-345-2040
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | INTERNAL MEDICINE
-----------------------------------------------------
Name | DR. PETER EUPIERRE
-----------------------------------------------------
Credential | M.D
-----------------------------------------------------
Telephone | 708-345-2035
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 036064214
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------