Provider Demographics
NPI:1154647550
Name:PEUSTER, MATTHIAS (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:MATTHIAS
Middle Name:
Last Name:PEUSTER
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5535 S BLACKSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-1833
Mailing Address - Country:US
Mailing Address - Phone:773-702-1022
Mailing Address - Fax:773-834-3795
Practice Address - Street 1:5841 S MARYLAND AVE
Practice Address - Street 2:K355, MC 4051
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1447
Practice Address - Country:US
Practice Address - Phone:773-705-4475
Practice Address - Fax:773-834-3795
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-12
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL113000057208000000X, 2080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics