Provider Demographics
NPI:1497787923
Name:LIO, PETER A (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:A
Last Name:LIO
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 1:363 W ERIE ST # 350
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-6903
Mailing Address - Country:US
Mailing Address - Phone:312-995-1955
Mailing Address - Fax:312-995-1956
Practice Address - Street 1:363 W ERIE ST # 350
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-6903
Practice Address - Country:US
Practice Address - Phone:312-995-1955
Practice Address - Fax:312-995-1956
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036120840207N00000X
MA222029207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2101700Medicaid
MA2101700Medicaid