Provider Demographics
NPI:1063426880
Name:PETERS, SELENA B (MD)
Entity type:Individual
Prefix:
First Name:SELENA
Middle Name:B
Last Name:PETERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 SKOKIE BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-1601
Mailing Address - Country:US
Mailing Address - Phone:866-729-1012
Mailing Address - Fax:847-996-2147
Practice Address - Street 1:40 SKOKIE BLVD STE 300
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-1601
Practice Address - Country:US
Practice Address - Phone:866-729-1012
Practice Address - Fax:847-996-2147
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI36166538207LA0401X, 2084A0401X
WI54751207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction Medicine
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine