Provider Demographics
NPI:1518981695
Name:SCHILKE, PETER W (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:W
Last Name:SCHILKE
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:PO BOX 1886
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-1886
Mailing Address - Country:US
Mailing Address - Phone:308-630-1398
Mailing Address - Fax:308-632-7830
Practice Address - Street 1:4021 AVENUE B
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-4602
Practice Address - Country:US
Practice Address - Phone:308-630-1398
Practice Address - Fax:308-632-7830
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE21583207ZP0102X
GA038604207ZP0102X
PAMD-058986-L207ZP0102X
SD4853207ZP0102X
WY6567A207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE35219OtherBC/BS
SD7704450Medicaid
SD4853OtherDAKOTACARE
NEH30508Medicare UPIN
SD7704450Medicaid