Provider Demographics
NPI:1558382366
Name:BESSETTE, PETER R (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:R
Last Name:BESSETTE
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 1:1420 RENAISSANCE DR STE 307
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1343
Mailing Address - Country:US
Mailing Address - Phone:847-803-1000
Mailing Address - Fax:469-522-6889
Practice Address - Street 1:1420 RENAISSANCE DR STE 307
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1343
Practice Address - Country:US
Practice Address - Phone:847-803-1000
Practice Address - Fax:469-522-6889
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME5637482085R0202X
NC2018-011632085R0202X
TXS15652085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31966300Medicaid
WI31966300Medicaid