Provider Demographics
NPI:1699853911
Name:OLGA M PEPLOS MD PC
Entity Type:Organization
Organization Name:OLGA M PEPLOS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PEPLOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-941-1580
Mailing Address - Street 1:114 W WAVERLY ST
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-1422
Mailing Address - Country:US
Mailing Address - Phone:815-941-1580
Mailing Address - Fax:815-941-1584
Practice Address - Street 1:114 W WAVERLY ST
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-1422
Practice Address - Country:US
Practice Address - Phone:815-941-1580
Practice Address - Fax:815-941-1584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036088029207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILDQ2434OtherRAILROAD MEDICARE
IL036088029001Medicaid
IL3227807OtherBLUE CROSS BLUE SHIELD
IL036088029001Medicaid
IL952200Medicare PIN