Provider Demographics
NPI:1265438790
Name:SPRINGSTEEN, PETER W (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:W
Last Name:SPRINGSTEEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3074 N US 31 S
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-4533
Mailing Address - Country:US
Mailing Address - Phone:231-929-1234
Mailing Address - Fax:231-935-0984
Practice Address - Street 1:3074 N US 31 S
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-4533
Practice Address - Country:US
Practice Address - Phone:231-929-1234
Practice Address - Fax:231-935-0984
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2020-12-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301046107207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI383530686OtherPPOM
MI1265438790OtherPETER SPRINGSTEEN MD
MI121593OtherUNITED HEALTH
MI349386200OtherUS POSTAL
MI700B810660OtherBLUE CARE NETWORK
MIB45155OtherPRIORITY HEALTH
MI38353068651OtherCOMMUNITY CHOICE
MI132959OtherCARE CHOICES
MI000000010478OtherCAP HEALTH
MI080181251OtherRAILROAD MEDICARE
MI080B810330OtherBCBS OF MICHIGAN
MI1851344964OtherURGENT CARE OF TRAVERSE CITY
MI4391565Medicaid
MI349386200OtherUS POSTAL
MIB45155Medicare UPIN