Active NPI
Lisa J Peters, MD
- Plastic Surgery Physician
- Forest Park, IL
National Provider Identifier
1710923164
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Plastic Surgery Physician
- License
- 036107308
- Practice address
- 7236 Madison St
Forest Park, IL 60130-1765 - Phone
- (708) 524-1400
- Fax
- (708) 524-1441
- NPI assigned
- Jun 22, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Plastic Surgery Physician | 208200000X | 036107308 | IL | Primary |
Addresses
Primary practice location
7236 Madison St
Forest Park, IL 60130-1765
Mailing address
7236 Madison St
Forest Park, IL 60130-1765
Phone (708) 524-1400
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 1, 2022 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150934400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1693353600000",
"number": "1710923164",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7236 MADISON ST",
"city": "FOREST PARK",
"state": "IL",
"postal_code": "601301765",
"telephone_number": "708-524-1400",
"fax_number": "708-524-1441"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7236 MADISON ST",
"city": "FOREST PARK",
"state": "IL",
"postal_code": "601301765",
"telephone_number": "708-524-1400",
"fax_number": "708-524-1441"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERS",
"first_name": "LISA",
"middle_name": "J",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-22",
"last_updated": "2023-08-30",
"certification_date": "2023-08-30",
"status": "A"
},
"taxonomies": [
{
"code": "208200000X",
"taxonomy_group": "",
"desc": "Plastic Surgery",
"state": "IL",
"license": "036107308",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Forest Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.