=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891794681
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THOMAS PEETERS MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/14/2005
-----------------------------------------------------
Last Update Date | 08/02/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3701 DOTY RD
-----------------------------------------------------
City | WOODSTOCK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60098-7509
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-334-3141
-----------------------------------------------------
Fax | 847-206-3464
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4201 W MEDICAL CENTER DR
-----------------------------------------------------
City | MCHENRY
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60050-8409
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-759-4293
-----------------------------------------------------
Fax | 815-759-8098
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number | 036045977
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------