Provider Demographics
NPI:1205092855
Name:PETER AKERELE
Entity type:Organization
Organization Name:PETER AKERELE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:AKERELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-978-2100
Mailing Address - Street 1:175 N HARBOR DR APT 3906
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7885
Mailing Address - Country:US
Mailing Address - Phone:773-978-2100
Mailing Address - Fax:773-978-1568
Practice Address - Street 1:2223 E 79TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649-5016
Practice Address - Country:US
Practice Address - Phone:773-978-2100
Practice Address - Fax:773-978-1568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-04
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016003216Medicaid
IL016003216Medicaid