Provider Demographics
NPI:1184782872
Name:PETER D. GELDNER, M.D. S.C.
Entity type:Organization
Organization Name:PETER D. GELDNER, M.D. S.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:GELDNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-981-4440
Mailing Address - Street 1:680 N LAKE SHORE DRIVE
Mailing Address - Street 2:SUITE 1325
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611
Mailing Address - Country:US
Mailing Address - Phone:312-981-4440
Mailing Address - Fax:312-981-4441
Practice Address - Street 1:680 N LAKE SHORE DRIVE
Practice Address - Street 2:SUITE 1325
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:312-981-4440
Practice Address - Fax:312-981-4441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36069136208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E44507Medicare UPIN
IL210107Medicare PIN