Provider Demographics
NPI:1144493255
Name:ALBERT PECHEREK SC.
Entity type:Organization
Organization Name:ALBERT PECHEREK SC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:PECHEREK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-763-9305
Mailing Address - Street 1:6438 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-2046
Mailing Address - Country:US
Mailing Address - Phone:773-763-9305
Mailing Address - Fax:773-763-9368
Practice Address - Street 1:6438 N. MILWAUKEE AVE.
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631
Practice Address - Country:US
Practice Address - Phone:773-763-9305
Practice Address - Fax:773-763-9368
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALBERT PECHEREK SC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG62433Medicare UPIN