Provider Demographics
NPI:1790780765
Name:PEIKEN, MARVIN S (MD)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:S
Last Name:PEIKEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5999 NEW WILKE RD
Mailing Address - Street 2:SUITE 200 BLDG 2
Mailing Address - City:ROLLING MEADOWS
Mailing Address - State:IL
Mailing Address - Zip Code:60008-4506
Mailing Address - Country:US
Mailing Address - Phone:847-255-7107
Mailing Address - Fax:847-255-7031
Practice Address - Street 1:5999 NEW WILKE RD
Practice Address - Street 2:SUITE 200 BLDG 2
Practice Address - City:ROLLING MEADOWS
Practice Address - State:IL
Practice Address - Zip Code:60008-4506
Practice Address - Country:US
Practice Address - Phone:847-255-7107
Practice Address - Fax:847-255-7031
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036053584207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036053584Medicaid
ILPO7225Medicare ID - Type Unspecified
IL036053584Medicaid