Provider Demographics
NPI:1184638496
Name:COLEGROVE, PETER M (MD)
Entity Type:Individual
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First Name:PETER
Middle Name:M
Last Name:COLEGROVE
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2650 RIDGE AVE
Mailing Address - Street 2:EVANSTON HOSPITAL
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1718
Mailing Address - Country:US
Mailing Address - Phone:847-570-1206
Mailing Address - Fax:847-570-1248
Practice Address - Street 1:1000 CENTRAL ST
Practice Address - Street 2:SUITE 720
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-1777
Practice Address - Country:US
Practice Address - Phone:847-475-8600
Practice Address - Fax:847-475-8654
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2021-02-08
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Provider Licenses
StateLicense IDTaxonomies
IL036112977208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I04692Medicare UPIN