Provider Demographics
NPI:1942423587
Name:PETER R. LEWY, MD, LTD
Entity type:Organization
Organization Name:PETER R. LEWY, MD, LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:R
Authorized Official - Last Name:LEWY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-256-6480
Mailing Address - Street 1:1100 CENTRAL AVE
Mailing Address - Street 2:SUITE H
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-2666
Mailing Address - Country:US
Mailing Address - Phone:847-256-6480
Mailing Address - Fax:847-256-6482
Practice Address - Street 1:1100 CENTRAL AVE
Practice Address - Street 2:SUITE H
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-2666
Practice Address - Country:US
Practice Address - Phone:847-256-6480
Practice Address - Fax:847-256-6482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042004736174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD12428Medicare UPIN