Provider Demographics
NPI:1376522490
Name:PECKLER, M SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:M
Middle Name:SCOTT
Last Name:PECKLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7900 MILWAUKEE
Mailing Address - Street 2:SUITE 222
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714
Mailing Address - Country:US
Mailing Address - Phone:847-967-9430
Mailing Address - Fax:847-967-9218
Practice Address - Street 1:7900 MILWAUKEE
Practice Address - Street 2:SUITE 222
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714
Practice Address - Country:US
Practice Address - Phone:847-967-9430
Practice Address - Fax:847-967-9218
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036043322208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036043322Medicaid
IL036043322Medicaid
C43009Medicare UPIN