MEDICARE: PETER WERNER M.D.

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	207RP1001X	Pulmonary Disease Physician	036046395	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01605969	OTHER	IL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114924347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER WERNER M.D.

Provider Business Mailing Address
First Line	:	7607 MADISON ST
Second Line	:
City	:	FOREST PARK
State	:	IL
Zip	:	60130-3513
Country	:	US
Telephone Number	:	708-366-7177
Fax Number	:	708-366-3301

Provider Business Practice Location Address
First Line	:	150 N RIVER RD
Second Line	:	SUITE 210
City	:	DES PLAINES
State	:	IL
Zip	:	60016-1272
Country	:	US
Telephone Number	:	847-759-4060
Fax Number	:	847-759-4066

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

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	12/01/2011

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Directions to “ PETER WERNER M.D.” Practice Location

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