Provider Demographics
NPI:1063450229
Name:ROSSI, PETER JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:JOHN
Last Name:ROSSI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:VASCULAR SURGERY/GENERAL SURGERY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-9160
Mailing Address - Fax:414-805-9170
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:VASCULAR SURGERY/GENERAL SURGERY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-9160
Practice Address - Fax:414-805-9170
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI471532086S0129X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036107064Medicaid
WI1063450229Medicaid
IL213773Medicare PIN
IL036107064Medicaid
WI736011420Medicare PIN
WI680860829Medicare PIN