Provider Demographics
NPI:1285735142
Name:MAYOCK, PETER PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:PAUL
Last Name:MAYOCK
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 1:845 W WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-8090
Mailing Address - Country:US
Mailing Address - Phone:773-506-4283
Mailing Address - Fax:
Practice Address - Street 1:845 W WILSON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-8090
Practice Address - Country:US
Practice Address - Phone:773-506-4283
Practice Address - Fax:773-989-5986
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036084492207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL29444Medicare ID - Type Unspecified
ILF72862Medicare UPIN