Provider Demographics
NPI:1326048448
Name:PECK, DAVID MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MICHAEL
Last Name:PECK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:25925 TELEGRAPH RD
Mailing Address - Street 2:210
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-2518
Mailing Address - Country:US
Mailing Address - Phone:248-746-0342
Mailing Address - Fax:248-746-0308
Practice Address - Street 1:47601 GRAND RIVER AVE
Practice Address - Street 2:A105
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1233
Practice Address - Country:US
Practice Address - Phone:248-465-4782
Practice Address - Fax:248-465-4852
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2007-07-17
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Provider Licenses
StateLicense IDTaxonomies
MI4301053134207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI468067510Medicaid
MI0F36020037Medicare ID - Type Unspecified
MI468067510Medicaid