Provider Demographics
NPI:1831204734
Name:SERAPHIN, PETER L (DO)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:L
Last Name:SERAPHIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 SALT CREEK LN
Mailing Address - Street 2:SUITE 425
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-8605
Mailing Address - Country:US
Mailing Address - Phone:630-789-2260
Mailing Address - Fax:630-789-1584
Practice Address - Street 1:12 SALT CREEK LN
Practice Address - Street 2:SUITE 425
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-8605
Practice Address - Country:US
Practice Address - Phone:630-789-2260
Practice Address - Fax:630-789-1584
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036107633207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL362658747OtherFEDERAL TAX ID