Provider Demographics
NPI:1851320956
Name:PECKUS, JOLANTA A (MD)
Entity Type:Individual
Prefix:DR
First Name:JOLANTA
Middle Name:A
Last Name:PECKUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 S MCHENRY
Mailing Address - Street 2:IMMEDIATE CARE
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-3115
Mailing Address - Country:US
Mailing Address - Phone:847-459-6100
Mailing Address - Fax:847-541-4857
Practice Address - Street 1:800 W CENTRAL RD
Practice Address - Street 2:NORTHWEST COMMUNITY HOSPITAL
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-2349
Practice Address - Country:US
Practice Address - Phone:847-618-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-040205207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-040205 D13748Medicare UPIN