Provider Demographics
NPI:1942217542
Name:PETERS, ELEANOR K (MD)
Entity Type:Individual
Prefix:DR
First Name:ELEANOR
Middle Name:K
Last Name:PETERS
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 1:101 W UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-3909
Mailing Address - Country:US
Mailing Address - Phone:217-442-8611
Mailing Address - Fax:
Practice Address - Street 1:108 ROBINSON ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-8515
Practice Address - Country:US
Practice Address - Phone:217-442-8611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-112507207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036112507 1Medicaid
279500OtherMEDICARE GROUP
P00233359OtherRAILROAD MEDICARE
ILH83927Medicare UPIN
279500OtherMEDICARE GROUP
IL0407950001Medicare NSC