Provider Demographics
NPI:1720152317
Name:ALLEGRETTI, PETER GERALD (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:GERALD
Last Name:ALLEGRETTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 W PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-2600
Mailing Address - Country:US
Mailing Address - Phone:847-362-2311
Mailing Address - Fax:847-362-2369
Practice Address - Street 1:535 W PARK AVE
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-2600
Practice Address - Country:US
Practice Address - Phone:847-362-2311
Practice Address - Fax:847-362-2369
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-58691207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036058691Medicaid
IL049-00922OtherBLUE CROSS BLUE SHIELD
IL036058691Medicaid
IL049-00922OtherBLUE CROSS BLUE SHIELD