Provider Demographics
NPI:1356045868
Name:PETERS, BENJAMIN OBADIAH (DO)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:OBADIAH
Last Name:PETERS
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 1:4220 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2793
Mailing Address - Country:US
Mailing Address - Phone:312-949-4200
Mailing Address - Fax:708-423-1899
Practice Address - Street 1:4220 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2793
Practice Address - Country:US
Practice Address - Phone:312-949-4200
Practice Address - Fax:708-423-1899
Is Sole Proprietor?:No
Enumeration Date:2023-03-28
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.081586208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics