Provider Demographics
NPI:1558327320
Name:MARKS, PETER H (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:H
Last Name:MARKS
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 1:1969 W. HART ROAD
Mailing Address - Street 2:BELOIT HEALTH SYSTEM INC
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-2298
Mailing Address - Country:US
Mailing Address - Phone:608-364-5011
Mailing Address - Fax:608-364-5593
Practice Address - Street 1:1969 W. HART ROAD
Practice Address - Street 2:BELOIT HEALTH SYSTEM INC
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-2298
Practice Address - Country:US
Practice Address - Phone:608-364-5011
Practice Address - Fax:608-364-5593
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI45518-20208G00000X
IL036-060891208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1558327320Medicaid
IL036060891Medicaid
WI1558327320Medicaid