Individual
MR. NEILL T PETERS
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5525 S PULASKI RD, CHICAGO, IL 60629-4417
(773) 585-1955
(773) 284-5268
Mailing address
2525 S MICHIGAN AVE, B-390, CHICAGO, IL 60616-2333
(312) 567-6691
(312) 328-7895
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01621679
BCBS OF IL
IL
05
—
036095483 / 03
—
IL
Enumeration date
12/07/2005
Last updated
07/08/2007
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