Provider Demographics
NPI:1174748396
Name:PEYKAR, SIDNEY (MD)
Entity type:Individual
Prefix:DR
First Name:SIDNEY
Middle Name:
Last Name:PEYKAR
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:PO BOX 510363
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33951-0363
Mailing Address - Country:US
Mailing Address - Phone:800-771-7164
Mailing Address - Fax:800-773-7581
Practice Address - Street 1:21300 GERTRUDE AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-5002
Practice Address - Country:US
Practice Address - Phone:800-771-7164
Practice Address - Fax:800-773-7581
Is Sole Proprietor?:No
Enumeration Date:2007-04-14
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2003-0134207R00000X
FLME92434207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMH86447Medicare UPIN
FLAF302YMedicare PIN