Provider Demographics
NPI:1881882868
Name:PETER E EUPIERRE M.D P.C
Entity type:Organization
Organization Name:PETER E EUPIERRE M.D P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERNAL MEDICINE
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:EUPIERRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-345-2035
Mailing Address - Street 1:1111 SUPERIOR ST
Mailing Address - Street 2:SUITE 408
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160-4158
Mailing Address - Country:US
Mailing Address - Phone:708-345-2035
Mailing Address - Fax:708-345-2040
Practice Address - Street 1:1111 SUPERIOR ST
Practice Address - Street 2:SUITE 408
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-4158
Practice Address - Country:US
Practice Address - Phone:708-345-2035
Practice Address - Fax:708-345-2040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036064214207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036064214Medicaid
IL31601170OtherBCBS
IL036064214Medicaid