Provider Demographics
NPI:1518965912
Name:PICK, PETER WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:WILLIAM
Last Name:PICK
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 1:1500 WEISS STREET
Mailing Address - Street 2:MEDICAL SERVICE-NEUROLOGY 111, VAMC
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602
Mailing Address - Country:US
Mailing Address - Phone:414-510-8454
Mailing Address - Fax:
Practice Address - Street 1:1500 WEISS STREET
Practice Address - Street 2:MEDICAL SERVICE-NEUROLOGY 111, VAMC
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602
Practice Address - Country:US
Practice Address - Phone:414-510-8454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-09
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI40043207ZN0500X, 207ZP0102X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207ZN0500XAllopathic & Osteopathic PhysiciansPathologyNeuropathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34316700Medicaid
601617600OtherDOLOWCP
G18772Medicare UPIN