Provider Demographics
NPI:1508824111
Name:NORVID, PETER (MD)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:
Last Name:NORVID
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 1:5101 WILLOW SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-2600
Mailing Address - Country:US
Mailing Address - Phone:708-245-4073
Mailing Address - Fax:708-245-5614
Practice Address - Street 1:5101 WILLOW SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-2600
Practice Address - Country:US
Practice Address - Phone:708-245-4073
Practice Address - Fax:708-245-5614
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36092887207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CN4921OtherRRMC
ILF87243Medicare UPIN
208342OtherGROUP MEDICARE PTAN
208341OtherGROUP MEDICARE PTAN
IL036092887Medicaid