Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | 036039917 | IL |
NPI | 1841277928 |
---|---|
Provider Name | Dr. Peter R Lewy |
First Address | Wilmette, IL 60091-2604 |
Second Address | Wilmette, IL 60091-2604 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2005 |
Last Update Date | 10/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D12428 | (02) |