Provider Demographics
NPI:1689675118
Name:HAUSLEIN, PETER DAWSON (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:DAWSON
Last Name:HAUSLEIN
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 1:582 N SEMINARY ST
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401-3739
Mailing Address - Country:US
Mailing Address - Phone:309-343-9393
Mailing Address - Fax:309-343-2107
Practice Address - Street 1:582 N SEMINARY ST
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-3739
Practice Address - Country:US
Practice Address - Phone:309-343-9393
Practice Address - Fax:309-343-2107
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-058861207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK35479Medicare PIN
ILC37234Medicare UPIN