Provider Demographics
NPI:1063546240
Name:PEOPLES, BRUCE DALE (MD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:DALE
Last Name:PEOPLES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 BUTTERFIELD RD
Mailing Address - Street 2:STE 130
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-5641
Mailing Address - Country:US
Mailing Address - Phone:630-371-0133
Mailing Address - Fax:630-371-0138
Practice Address - Street 1:5002 W MADISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60644-4127
Practice Address - Country:US
Practice Address - Phone:773-379-1000
Practice Address - Fax:773-379-1342
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36094936207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK13768Medicare UPIN