Provider Demographics
NPI:1114924347
Name:WERNER, PETER (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:WERNER
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 1:7607 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60130-3513
Mailing Address - Country:US
Mailing Address - Phone:708-366-7177
Mailing Address - Fax:708-366-3301
Practice Address - Street 1:150 N RIVER RD
Practice Address - Street 2:SUITE 210
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-1272
Practice Address - Country:US
Practice Address - Phone:847-759-4060
Practice Address - Fax:847-759-4066
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-01
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036046395207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01605969OtherBCBS
IL036046395Medicaid
IL476616Medicare PIN
IL036046395Medicaid