Provider Demographics
NPI:1942628383
Name:PEAKLIFEMD, S.C.
Entity Type:Organization
Organization Name:PEAKLIFEMD, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:UTPAL
Authorized Official - Middle Name:
Authorized Official - Last Name:DHRUVE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-946-0855
Mailing Address - Street 1:303 W OHIO ST
Mailing Address - Street 2:UNIT 2007
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-7963
Mailing Address - Country:US
Mailing Address - Phone:847-946-0855
Mailing Address - Fax:
Practice Address - Street 1:1603 ORRINGTON AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3841
Practice Address - Country:US
Practice Address - Phone:847-946-0855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-02
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361288752084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty