Provider Demographics
NPI:1700984408
Name:SAND, PETER KEVIN (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:KEVIN
Last Name:SAND
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9650 GROSS POINT RD # 3900
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1214
Mailing Address - Country:US
Mailing Address - Phone:224-251-2374
Mailing Address - Fax:847-933-3531
Practice Address - Street 1:9650 GROSS POINT RD # 3900
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076
Practice Address - Country:US
Practice Address - Phone:224-251-2374
Practice Address - Fax:847-933-3531
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2019-11-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036064560207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyUrogynecology and Reconstructive Pelvic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILA52280Medicare UPIN