Provider Demographics
NPI:1487640660
Name:PEDDINGHAUS, WOLF D (MD)
Entity Type:Individual
Prefix:DR
First Name:WOLF
Middle Name:D
Last Name:PEDDINGHAUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:9701 KNOX AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1256
Mailing Address - Country:US
Mailing Address - Phone:847-677-1112
Mailing Address - Fax:847-674-3358
Practice Address - Street 1:9701 KNOX AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1256
Practice Address - Country:US
Practice Address - Phone:847-677-1112
Practice Address - Fax:847-674-3358
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2011-04-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL36053477207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine