Provider Demographics
NPI:1487840252
Name:WHEATON PEDIATRICS, LTD.
Entity Type:Organization
Organization Name:WHEATON PEDIATRICS, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:I
Authorized Official - Last Name:LIBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-690-7300
Mailing Address - Street 1:55 E LOOP RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-2038
Mailing Address - Country:US
Mailing Address - Phone:630-690-7300
Mailing Address - Fax:630-690-7335
Practice Address - Street 1:55 E LOOP RD
Practice Address - Street 2:SUITE 301
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-2038
Practice Address - Country:US
Practice Address - Phone:630-690-7300
Practice Address - Fax:630-690-7335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-14
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty