Provider Demographics
NPI:1801418363
Name:HARVEY, PETER GERARD (LAC, MSOM, FABORM)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:GERARD
Last Name:HARVEY
Suffix:
Gender:M
Credentials:LAC, MSOM, FABORM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 EAST WILLOW AVENUE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187
Mailing Address - Country:US
Mailing Address - Phone:630-653-4358
Mailing Address - Fax:630-653-8101
Practice Address - Street 1:200 EAST WILLOW AVENUE
Practice Address - Street 2:SUITE 202
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187
Practice Address - Country:US
Practice Address - Phone:630-653-4358
Practice Address - Fax:630-653-8101
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-07
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198.00534171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist