Provider Demographics
NPI:1720032311
Name:ANALYTIS, PETER D (MD SC)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:D
Last Name:ANALYTIS
Suffix:
Gender:M
Credentials:MD SC
Other - Prefix:
Other - First Name:JOLIET HEADACHE &
Other - Middle Name:NEURO
Other - Last Name:CENTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:725 SCHOOL ST STE A
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-1207
Mailing Address - Country:US
Mailing Address - Phone:815-941-9124
Mailing Address - Fax:815-941-4363
Practice Address - Street 1:1499 LAKEWOOD DR STE I
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-1709
Practice Address - Country:US
Practice Address - Phone:815-941-7533
Practice Address - Fax:815-941-6876
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360618852084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036061885Medicaid
ILK07502OtherMEDICARE GRUNDY
ILK07501OtherMEDICARE WILL
IL130003473Medicare PIN
IL209061Medicare PIN
IL29060Medicare ID - Type Unspecified
IL036061885Medicaid
ILK07502OtherMEDICARE GRUNDY