Organization
ELITE GYNECOLOGY S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PETER P VIENNE JR. D.O. (OWNER/PRESIDENT)
(815) 942-0525
Entity
Organization
Contact information
Practice address
936 W US ROUTE 6, MORRIS, IL 60450-8858
(815) 942-0525
(815) 942-3501
Mailing address
936 W US ROUTE 6, MORRIS, IL 60450-8858
(815) 942-0525
(815) 942-3501
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
036082983
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3229984
BLUE CROSS BLUE SHIELD
IL
Enumeration date
07/20/2007
Last updated
07/01/2015
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