Individual
DR. PETER WALTER DEMUTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
717 MAIN ST, 2ND FLOOR EAST, EVANSTON, IL 60202
(847) 424-9304
Mailing address
476 SHERIDAN ROAD, #2, EVANSTON, IL 60202
(847) 424-9304
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01622016
BCBS PRO #
—
Enumeration date
11/20/2006
Last updated
07/08/2007
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