Provider Demographics
NPI:1073644092
Name:LOURGOS, PETER (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:LOURGOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7447 W LAWLER AVE
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-3107
Mailing Address - Country:US
Mailing Address - Phone:708-719-1695
Mailing Address - Fax:888-947-7879
Practice Address - Street 1:7447 W LAWLER AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-3107
Practice Address - Country:US
Practice Address - Phone:855-629-0554
Practice Address - Fax:888-947-7879
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN612622084P0800X
UT11699556-12052084P0800X
OK356772084P0800X
NV197112084P0800X
MDD890752084P0800X
NE324392084P0800X
MN670192084P0800X
WAMD610537032084P0800X
KS04-430642084P0800X
WI525-3202084P0800X
IAMD-471402084P0800X
AZ608492084P0800X
MTMED-PHYS-LIC-852782084P0800X
COCDR.00006592084P0800X
IL036-1052492084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry