Provider Demographics
NPI:1437141223
Name:PEPPER, BETSY (MD)
Entity Type:Individual
Prefix:DR
First Name:BETSY
Middle Name:
Last Name:PEPPER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:467 W DEMING PL
Mailing Address - Street 2:SUITE 500
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1881
Mailing Address - Country:US
Mailing Address - Phone:773-388-6390
Mailing Address - Fax:
Practice Address - Street 1:467 W DEMING PL
Practice Address - Street 2:SUITE 500
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1881
Practice Address - Country:US
Practice Address - Phone:773-388-6390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36-055211174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILE18835Medicare UPIN
ILL30739Medicare PIN