Provider Demographics
NPI:1003063173
Name:BAIK, PETER UNGJO (DO)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:UNGJO
Last Name:BAIK
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 1:2361 PAYSPHERE CIRCLE
Mailing Address - Street 2:CANCER TREATMENT CENTERS OF AMERICA
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674
Mailing Address - Country:US
Mailing Address - Phone:800-322-9183
Mailing Address - Fax:
Practice Address - Street 1:2520 ELISHA AVENUE
Practice Address - Street 2:CANCER TREATMENT CENTERS OF AMERICA
Practice Address - City:ZION
Practice Address - State:IL
Practice Address - Zip Code:60099
Practice Address - Country:US
Practice Address - Phone:800-322-9183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-20
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.143737208G00000X
AZ007606208G00000X
OK5499208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)