MEDICARE: THOMAS PEETERS 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	207P00000X	Emergency Medicine Physician	036045977	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891794681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS PEETERS MD

Provider Business Mailing Address
First Line	:	4201 W MEDICAL CENTER DR
Second Line	:
City	:	MCHENRY
State	:	IL
Zip	:	60050-8409
Country	:	US
Telephone Number	:	815-759-4293
Fax Number	:	815-759-8098

Provider Business Practice Location Address
First Line	:	3701 DOTY RD
Second Line	:
City	:	WOODSTOCK
State	:	IL
Zip	:	60098-7509
Country	:	US
Telephone Number	:	815-334-3141
Fax Number	:	847-206-3464

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

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	08/02/2017

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Directions to “ THOMAS PEETERS MD” Practice Location

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