Organization
C.G.PETERS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CONSTANTINE G PETERS D.O. (OWNER)
(708) 389-9226
Entity
Organization
Contact information
Practice address
13305 S RIDGELAND AVE, UNIT B, PALOS HEIGHTS, IL 60463-1808
(708) 389-9226
(708) 389-2004
Mailing address
PO BOX 276, PALOS HEIGHTS, IL 60463-0276
(708) 389-9226
(708) 389-2004
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
036107020
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036107020
—
IL
Enumeration date
10/02/2006
Last updated
04/04/2012
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