MEDICARE: DR. PETER ANDREW DRAHOS DDS

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	1223G0001X	General Practice Dentistry	019027907	IL

General Provider Information

NPI Number	:	1407082001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER ANDREW DRAHOS DDS

Provider Business Mailing Address
First Line	:	10 COVE CT
Second Line	:
City	:	BURR RIDGE
State	:	IL
Zip	:	60527-8369
Country	:	US
Telephone Number	:	630-337-9986
Fax Number	:

Provider Business Practice Location Address
First Line	:	6800 W ARCHER AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60638-2312
Country	:	US
Telephone Number	:	312-788-1001
Fax Number	:

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

Provider Enumeration Date	:	06/09/2009
Last Update Date	:	06/09/2009

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