Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 113000057 | IL |
Y | 2080P0202X | Pediatric Cardiologist | 113000057 | IL |
NPI | 1154647550 |
---|---|
Provider Name | Dr. Matthias Peuster |
First Address | Chicago, IL 60637-1833 |
Second Address | Chicago, IL 60637-1447 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2010 |
Last Update Date | 11/03/2013 |