Basic Information
| Provider Information | |||||||||
| NPI: | 1538614441 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DOUKAS | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | G | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 251 E HURON ST | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606112908 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 240 E HURON ST STE 1-200 | ||||||||
| Address2: | NORTHWESTERN MEDICINE MCGAW MEDICAL CENTER | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606112909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3125037975 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2016 | ||||||||
| LastUpdateDate: | 06/13/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | IL | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | 125.075562 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.