Provider Demographics
NPI:1386688158
Name:KIEFER, PETER JURGEN (MD)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:JURGEN
Last Name:KIEFER
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 1:1000 REMINGTON BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4707
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:630-914-2469
Practice Address - Street 1:150 N RIVER RD STE 110
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-1272
Practice Address - Country:US
Practice Address - Phone:847-342-8956
Practice Address - Fax:847-342-8958
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036059034207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036059034Medicaid
IL036059034Medicaid
IL209407Medicare ID - Type Unspecified