Provider Demographics
NPI:1699824482
Name:PETTIGREW, ARTHUR S (MD)
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:S
Last Name:PETTIGREW
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 1:396 REMINGTON BLVD STE 380
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4302
Mailing Address - Country:US
Mailing Address - Phone:224-273-4000
Mailing Address - Fax:
Practice Address - Street 1:396 REMINGTON BLVD STE 380
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-4302
Practice Address - Country:US
Practice Address - Phone:224-273-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036101644207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL080158547OtherRAILROAD MEDICARE PTAN
IL399980OtherMEDICARE GROUP PTAN
IL036101644Medicaid
IL036101644Medicaid