Provider Demographics
NPI:1164414165
Name:NEFCY, PETER M (MD, PHD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:M
Last Name:NEFCY
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29900 LORRAINE AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-5266
Mailing Address - Country:US
Mailing Address - Phone:586-582-0864
Mailing Address - Fax:586-582-0964
Practice Address - Street 1:11012 E 13 MILE RD
Practice Address - Street 2:SUITE 111
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-2572
Practice Address - Country:US
Practice Address - Phone:586-558-8470
Practice Address - Fax:586-558-8481
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010460612085N0904X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4390361Medicaid
MI700E021830OtherBCBS
MI700E021910OtherBCBS
MI4484388Medicaid
MI700F340300OtherBCBS
MI4390361Medicaid
MI4484388Medicaid
MI700F340300OtherBCBS