Provider Demographics
NPI:1164669370
Name:PETER L. WINTERS, M.D. INC.
Entity Type:Organization
Organization Name:PETER L. WINTERS, M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:L
Authorized Official - Last Name:WINTERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-872-5295
Mailing Address - Street 1:8402 HARCOURT RD
Mailing Address - Street 2:SUITE 620
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2074
Mailing Address - Country:US
Mailing Address - Phone:317-872-5295
Mailing Address - Fax:371-875-8381
Practice Address - Street 1:8402 HARCOURT RD
Practice Address - Street 2:SUITE 620
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2074
Practice Address - Country:US
Practice Address - Phone:317-872-5295
Practice Address - Fax:371-875-8381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-09
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01021996A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INB28172Medicare UPIN
IN063040Medicare PIN