Provider Demographics
NPI:1265648802
Name:CHKOSKI, PETER FREDERICK (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:FREDERICK
Last Name:CHKOSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 N TUSTIN AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3807
Mailing Address - Country:US
Mailing Address - Phone:714-347-1000
Mailing Address - Fax:714-647-1245
Practice Address - Street 1:10866 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:TOLUCA LAKE
Practice Address - State:CA
Practice Address - Zip Code:91602-2236
Practice Address - Country:US
Practice Address - Phone:818-763-3489
Practice Address - Fax:818-763-6054
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC51414207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C514140Medicaid
CAP00241240Medicare PIN
CAB08426Medicare UPIN
CACB214624Medicare PIN
CAC51414Medicare PIN