Provider Demographics
NPI:1891766275
Name:CALABRESE, PETER A (DO)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:A
Last Name:CALABRESE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 W ADDISON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-3418
Mailing Address - Country:US
Mailing Address - Phone:773-625-1900
Mailing Address - Fax:773-625-5348
Practice Address - Street 1:7400 W ADDISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-3418
Practice Address - Country:US
Practice Address - Phone:773-625-1900
Practice Address - Fax:773-625-5348
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036075915207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080117917OtherRAILROAD MEDICARE
080117917OtherRAILROAD MEDICARE
L60123Medicare PIN