MEDICARE: MATTHEW C. PETERSON 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
1	2085R0202X	Diagnostic Radiology Physician	036-147076	IL
2	2085R0202X	Diagnostic Radiology Physician	R-7653	IA
3	2085R0202X	Diagnostic Radiology Physician	39188	IA

General Provider Information

NPI Number	:	1679782361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW C. PETERSON MD

Provider Business Mailing Address
First Line	:	29373 NETWORK PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60673-1293
Country	:	US
Telephone Number	:	847-390-5900
Fax Number	:

Provider Business Practice Location Address
First Line	:	450 W HIGHWAY 22
Second Line	:
City	:	BARRINGTON
State	:	IL
Zip	:	60010-1919
Country	:	US
Telephone Number	:	847-842-4136
Fax Number	:	847-842-4161

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

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	03/25/2026

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