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NPI Code Detail

MEDICARE: DR. ROSS CAMERON PEPPER MD

MEDICARE: DR. ROSS CAMERON PEPPER MD
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
12084P0800XPsychiatry Physician036.166098IL

General Provider Information

NPI Number : 1639639297
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROSS CAMERON PEPPER MD
Provider Business Mailing Address
First Line : 3665 N BROADWAY ST
Second Line :
City : CHICAGO
State : IL
Zip : 60613-4567
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3665 N BROADWAY ST
Second Line :
City : CHICAGO
State : IL
Zip : 60613-4567
Country : US
Telephone Number : 773-496-4433
Fax Number : 386-515-8239
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2019
Last Update Date : 07/16/2024

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