Provider Demographics
NPI:1093922346
Name:PECHTER, BRADLEY M (MD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:M
Last Name:PECHTER
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 1:675 W NORTH AVE
Mailing Address - Street 2:306
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160-1634
Mailing Address - Country:US
Mailing Address - Phone:847-329-9210
Mailing Address - Fax:708-681-9280
Practice Address - Street 1:675 W NORTH AVE
Practice Address - Street 2:306
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-1634
Practice Address - Country:US
Practice Address - Phone:847-329-9210
Practice Address - Fax:708-681-9280
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360839112084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF 94423Medicare UPIN