Provider Demographics
NPI:1770545717
Name:PEPLOW, RONALD J (DO SC)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:J
Last Name:PEPLOW
Suffix:
Gender:M
Credentials:DO SC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3204 N OAK PARK AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-4640
Mailing Address - Country:US
Mailing Address - Phone:773-736-3131
Mailing Address - Fax:773-736-9416
Practice Address - Street 1:7107 W BELMONT AVE
Practice Address - Street 2:S-10
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-4688
Practice Address - Country:US
Practice Address - Phone:773-889-3121
Practice Address - Fax:773-889-3914
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036058074207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C44314Medicare UPIN
IL210905Medicare ID - Type Unspecified