Provider Demographics
NPI:1114191632
Name:PECK, ANDREW MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:MICHAEL
Last Name:PECK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:120 W 22ND ST
Mailing Address - Street 2:NEPHROLOGY ASSOCIATES OF NORTHERN ILLINOIS
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1557
Mailing Address - Country:US
Mailing Address - Phone:630-573-5000
Mailing Address - Fax:
Practice Address - Street 1:601 W GOLF RD STE 105
Practice Address - Street 2:NEPHROLOGY ASSOC. OF NORTHERN ILLINOIS
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-4276
Practice Address - Country:US
Practice Address - Phone:847-439-8780
Practice Address - Fax:847-298-6395
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036119166207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036119166Medicaid