Individual provider · Type 1 NPI

Edmund Thomas Peacock, MD

Student in an Organized Health Care Education/Training Program · Chicago, IL

NPI number 1356239776 Active

Practice location

1750 W Harrison St Ste 108
Chicago, IL 60612-3825

Call (312) 942-7802 Map

Specialties and licenses

TaxonomyCodeLicense
Emergency Medicine Physician 207P00000X125.086315 (IL)
Student in an Organized Health Care Education/Training Program Primary 390200000X125.086315 (IL)

Student in an Organized Health Care Education/Training Program: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

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About NPI 1356239776

Edmund Thomas Peacock, MD's National Provider Identifier is 1356239776, issued on Jun 25, 2025. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in Chicago, IL. The record was last updated on Aug 5, 2025.