Provider Demographics
NPI:1669748018
Name:PEAK PERFORMANCE HEALTH CENTER LTD
Entity type:Organization
Organization Name:PEAK PERFORMANCE HEALTH CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:S
Authorized Official - Last Name:STUMBRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-440-9646
Mailing Address - Street 1:1749 N WELLS ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-5877
Mailing Address - Country:US
Mailing Address - Phone:312-420-2513
Mailing Address - Fax:
Practice Address - Street 1:1749 N WELLS ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-5877
Practice Address - Country:US
Practice Address - Phone:312-440-9646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEAK PERFORMANCE HEALTH CARE, LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-30
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site