Provider Demographics
NPI:1326043597
Name:MAVRELIS, PETER GEORGE (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:GEORGE
Last Name:MAVRELIS
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 1:7895 GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:HOBART
Mailing Address - State:IN
Mailing Address - Zip Code:46342-6665
Mailing Address - Country:US
Mailing Address - Phone:219-947-1910
Mailing Address - Fax:219-758-5009
Practice Address - Street 1:7895 GRAND BLVD
Practice Address - Street 2:
Practice Address - City:HOBART
Practice Address - State:IN
Practice Address - Zip Code:46342-6665
Practice Address - Country:US
Practice Address - Phone:219-947-1910
Practice Address - Fax:219-758-5009
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01030831A207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000085027OtherANTHEM BC/BS
IN100138640AMedicaid
IL9115389OtherANTHEM BC/BS
IN110044491OtherRAILROAD MEDICARE
IL9115389OtherANTHEM BC/BS
IN110044491OtherRAILROAD MEDICARE