Provider Demographics
NPI:1598746224
Name:MILLHEISER, PETER J (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:J
Last Name:MILLHEISER
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 1:9299 CORAL REEF DR
Mailing Address - Street 2:#104
Mailing Address - City:VILLAGE OF PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-1775
Mailing Address - Country:US
Mailing Address - Phone:305-251-2240
Mailing Address - Fax:305-238-1517
Practice Address - Street 1:9299 CORAL REEF DR
Practice Address - Street 2:#104
Practice Address - City:VILLAGE OF PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-1775
Practice Address - Country:US
Practice Address - Phone:305-251-2240
Practice Address - Fax:305-238-1517
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0016257207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL054260100Medicaid
D59653Medicare UPIN
FL054260100Medicaid