Provider Demographics
NPI:1346987062
Name:KING, PETER (COMPANY OWNER)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:KING
Suffix:
Gender:M
Credentials:COMPANY OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6511 BLUE SPRUCE CT
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48324-3713
Mailing Address - Country:US
Mailing Address - Phone:248-795-3613
Mailing Address - Fax:
Practice Address - Street 1:6511 BLUE SPRUCE CT
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48324-3713
Practice Address - Country:US
Practice Address - Phone:248-795-3613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-14
Last Update Date:2022-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver