Provider Demographics
NPI:1740225689
Name:PETER D COTEY DO PC
Entity Type:Organization
Organization Name:PETER D COTEY DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:D
Authorized Official - Last Name:COTEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:989-729-7778
Mailing Address - Street 1:1053 E MAIN ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-8417
Mailing Address - Country:US
Mailing Address - Phone:989-729-7778
Mailing Address - Fax:989-729-7680
Practice Address - Street 1:1053 E MAIN ST
Practice Address - Street 2:SUITE 204
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-8417
Practice Address - Country:US
Practice Address - Phone:989-729-7778
Practice Address - Fax:989-729-7680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101011399207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4131403Medicaid
MI4131403Medicare UPIN
MI4131403Medicaid