Provider Demographics
NPI:1821036047
Name:STECY, PETER J (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:J
Last Name:STECY
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 1:3118 N ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3014
Mailing Address - Country:US
Mailing Address - Phone:773-880-9722
Mailing Address - Fax:773-880-9723
Practice Address - Street 1:3118 N ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3014
Practice Address - Country:US
Practice Address - Phone:773-880-9722
Practice Address - Fax:773-880-9723
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036073386207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1487951711OtherNPI
IL1602375OtherBSBC
ILIL5276Medicare PIN