MEDICARE: DR. PETER A. PATSAVAS 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	122300000X	Dentist	019020055	IL

General Provider Information

NPI Number	:	1609056381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER A. PATSAVAS DDS

Provider Business Mailing Address
First Line	:	7001 W 127TH ST
Second Line	:	SUITE 101
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1573
Country	:	US
Telephone Number	:	708-361-1190
Fax Number	:	708-361-5541

Provider Business Practice Location Address
First Line	:	7001 W 127TH ST
Second Line	:	SUITE 101
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1573
Country	:	US
Telephone Number	:	708-361-1190
Fax Number	:	708-361-5541

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

Provider Enumeration Date	:	11/09/2007
Last Update Date	:	11/09/2007

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