Provider Demographics
NPI:1194802298
Name:PETER ROONEY LTD
Entity type:Organization
Organization Name:PETER ROONEY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:W
Authorized Official - Last Name:ROONEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-674-5828
Mailing Address - Street 1:777 OAKMONT LN
Mailing Address - Street 2:SUITE 1600
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5511
Mailing Address - Country:US
Mailing Address - Phone:630-789-2550
Mailing Address - Fax:
Practice Address - Street 1:9701 KNOX AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1256
Practice Address - Country:US
Practice Address - Phone:847-674-5828
Practice Address - Fax:847-933-6044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3160048876OtherBCBS PROVIDER ID
ILDB7213OtherRAILROAD MEDICARE
IL3160048876OtherBCBS PROVIDER ID
IL209185Medicare PIN