Provider Demographics
NPI:1740446277
Name:BROIDO, PETER W (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:W
Last Name:BROIDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:333 N. CANAL STREET
Mailing Address - Street 2:UNIT 3504
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-1543
Mailing Address - Country:US
Mailing Address - Phone:312-575-8512
Mailing Address - Fax:312-575-8513
Practice Address - Street 1:333 N. CANAL STREET
Practice Address - Street 2:UNIT 3504
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-1543
Practice Address - Country:US
Practice Address - Phone:312-575-8512
Practice Address - Fax:312-575-8513
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036042407208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery