Provider Demographics
NPI:1497866289
Name:GELDNER, PETER DAVID (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:DAVID
Last Name:GELDNER
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 1:680 N LAKE SHORE DR
Mailing Address - Street 2:STE 1325
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611
Mailing Address - Country:US
Mailing Address - Phone:312-981-4440
Mailing Address - Fax:312-981-4441
Practice Address - Street 1:680 N LAKE SHORE DR
Practice Address - Street 2:STE 1325
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:312-981-4440
Practice Address - Fax:312-981-4441
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36069136208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
210107Medicare ID - Type Unspecified
E44507Medicare UPIN