MEDICARE: DR. CONSTANTINE G PETERS D.O.

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	208M00000X	Hospitalist Physician	036107020	IL
2	207R00000X	Internal Medicine Physician	036107020	IL
3	208M00000X	Hospitalist Physician	OS17162	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1114937562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CONSTANTINE G PETERS D.O.

Provider Business Mailing Address
First Line	:	2338 IMMOKALEE RD # 186
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34110-1445
Country	:	US
Telephone Number	:	239-330-2933
Fax Number	:	239-343-5348

Provider Business Practice Location Address
First Line	:	12251 S 80TH AVE
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1290
Country	:	US
Telephone Number	:	708-923-4000
Fax Number	:	708-923-5859

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

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	01/13/2026

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Directions to “ DR. CONSTANTINE G PETERS D.O.” Practice Location

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