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NPI Code Detail

MEDICARE: PETER J. MCDONNELL M.D. SC

MEDICARE: PETER J. MCDONNELL M.D. SC
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
1174400000XSpecialistIL

General Provider Information

NPI Number : 1659435899
Entity Type Code : Organization
Provider Name (Legal Business Name) : PETER J. MCDONNELL M.D. SC
Provider Business Mailing Address
First Line : PO BOX 369
Second Line :
City : NEW LENOX
State : IL
Zip : 60451-0369
Country : US
Telephone Number : 815-463-0098
Fax Number : 815-462-4955
Provider Business Practice Location Address
First Line : 7530 W COLLEGE DR
Second Line :
City : PALOS HEIGHTS
State : IL
Zip : 60463-1196
Country : US
Telephone Number : 708-923-6605
Fax Number : 708-923-0705
Authorized Official
Title or Position : OWNER
Name : PETER J MCDONNELL
Credential : MD SC
Telephone Number : 708-923-6605
Provider Enumeration Date : 12/21/2006
Last Update Date : 08/22/2020

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