Provider Demographics
NPI:1093732331
Name:OSHIN, PETER M (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:M
Last Name:OSHIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 TOWER CT STE 265
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-3340
Mailing Address - Country:US
Mailing Address - Phone:847-623-8818
Mailing Address - Fax:847-625-8059
Practice Address - Street 1:15 TOWER CT STE 265
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3340
Practice Address - Country:US
Practice Address - Phone:847-623-8818
Practice Address - Fax:847-625-8059
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-094708207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036094708-1Medicaid
IL200658Medicare PIN
ILH54303Medicare UPIN