MEDICARE: PETER MAXWELL CIRRINCIONE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program		IL
2	207X00000X	Orthopaedic Surgery Physician	125084382	IL

General Provider Information

NPI Number	:	1053014779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER MAXWELL CIRRINCIONE

Provider Business Mailing Address
First Line	:	3140 N ELSTON AVE # APS1S
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-8576
Country	:	US
Telephone Number	:	847-284-0175
Fax Number	:

Provider Business Practice Location Address
First Line	:	3140 N ELSTON AVE # APS1S
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-8576
Country	:	US
Telephone Number	:	847-284-0175
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2023
Last Update Date	:	08/04/2025

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