Provider Demographics
NPI:1831792886
Name:ECCENTRIC LEARNING LABORATORIES, LLC
Entity type:Organization
Organization Name:ECCENTRIC LEARNING LABORATORIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:PLATTEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:608-213-9284
Mailing Address - Street 1:4765 N LINCOLN AVE STE 209
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-2077
Mailing Address - Country:US
Mailing Address - Phone:714-719-6740
Mailing Address - Fax:
Practice Address - Street 1:4765 N LINCOLN AVE STE 209
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-2077
Practice Address - Country:US
Practice Address - Phone:714-719-6740
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-20
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center