Provider Demographics
NPI:1629066758
Name:PEI, CLAIRE (DO)
Entity Type:Individual
Prefix:
First Name:CLAIRE
Middle Name:
Last Name:PEI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 S NEWBURGH RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:MI
Mailing Address - Zip Code:48184-1001
Mailing Address - Country:US
Mailing Address - Phone:734-729-7220
Mailing Address - Fax:734-729-7227
Practice Address - Street 1:2901 S NEWBURGH RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:MI
Practice Address - Zip Code:48184-1001
Practice Address - Country:US
Practice Address - Phone:734-729-7220
Practice Address - Fax:734-729-7227
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101014984207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4689741Medicaid
MI4689760Medicaid
I23585Medicare UPIN
MI4689741Medicaid