Provider Demographics
NPI:1225065063
Name:SCHOEPS, PETER R (DO)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:R
Last Name:SCHOEPS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26901 BEAUMONT BLVD STE 3D
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3849
Mailing Address - Country:US
Mailing Address - Phone:947-522-1863
Mailing Address - Fax:047-522-0307
Practice Address - Street 1:32756 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MI
Practice Address - Zip Code:48336-3133
Practice Address - Country:US
Practice Address - Phone:248-476-3280
Practice Address - Fax:248-476-3286
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101008985207QG0300X, 207Q00000X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIB2551OtherMCARE
MI5631016OtherBLUE CROSS
MIP45080OtherBLUE CROSS
MI128608OtherCARE CHOICES
MI4229882OtherAETNA
OM60100002Medicare ID - Type Unspecified
E73386Medicare UPIN