Provider Demographics
NPI:1356360531
Name:FRIEDELL, PETER E (M D)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:E
Last Name:FRIEDELL
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2850 S WABASH AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-2492
Mailing Address - Country:US
Mailing Address - Phone:312-808-0621
Mailing Address - Fax:312-808-0655
Practice Address - Street 1:2850 S WABASH AVE STE 203
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2492
Practice Address - Country:US
Practice Address - Phone:312-808-0621
Practice Address - Fax:312-808-0655
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-049-043207RB0002X
IL036-049043207RH0003X
MDD87004207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-049043Medicaid
IL036-049043Medicaid