Provider Demographics
NPI:1205803483
Name:NEALE, PETER HERBERT (DO)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:HERBERT
Last Name:NEALE
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 1:27702 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1277
Mailing Address - Country:US
Mailing Address - Phone:708-862-7674
Mailing Address - Fax:708-862-1781
Practice Address - Street 1:18127 WILLIAM ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438-3921
Practice Address - Country:US
Practice Address - Phone:708-889-6621
Practice Address - Fax:708-889-6675
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02002162A207Q00000X
IL036073399207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL231199029OtherMEDICARE
IL080096730OtherRRM
IL036073399Medicaid
IL036073399Medicaid
ILP00185058Medicare PIN