Provider Demographics
NPI:1174625420
Name:ALAN P PETER DO PC
Entity type:Organization
Organization Name:ALAN P PETER DO PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:PETER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:586-992-9970
Mailing Address - Street 1:16800 24 MILE RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:MACOMB TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48042
Mailing Address - Country:US
Mailing Address - Phone:586-992-9970
Mailing Address - Fax:586-992-9972
Practice Address - Street 1:16800 24 MILE RD
Practice Address - Street 2:SUITE 4
Practice Address - City:MACOMB TWP
Practice Address - State:MI
Practice Address - Zip Code:48042
Practice Address - Country:US
Practice Address - Phone:586-992-9970
Practice Address - Fax:586-992-9972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2008-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101014745207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E02052OtherBCBS GROUP PIN
MI114933018Medicaid
MI0P37230Medicare PIN
MI0E02052OtherBCBS GROUP PIN