Provider Demographics
NPI:1861622441
Name:KEORPES, PETER ANGELO (PA-C)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:ANGELO
Last Name:KEORPES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 SPRINGER DR
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-6413
Mailing Address - Country:US
Mailing Address - Phone:815-933-2227
Mailing Address - Fax:815-933-5278
Practice Address - Street 1:374 LARRY POWER RD
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-5187
Practice Address - Country:US
Practice Address - Phone:815-933-2227
Practice Address - Fax:815-933-5278
Is Sole Proprietor?:No
Enumeration Date:2009-07-17
Last Update Date:2017-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.004041363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL085.004041OtherSTATE LICSENSE