Provider Demographics
NPI:1760467104
Name:CHENG, PEGGY PING (MD)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:PING
Last Name:CHENG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22255 GREENFIELD RD STE 280
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-3712
Mailing Address - Country:US
Mailing Address - Phone:248-849-4990
Mailing Address - Fax:248-849-4991
Practice Address - Street 1:22255 GREENFIELD RD
Practice Address - Street 2:# 231
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3728
Practice Address - Country:US
Practice Address - Phone:248-569-0122
Practice Address - Fax:248-569-3758
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIPC070972207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4231955Medicaid
0M98380Medicare ID - Type Unspecified
MI4231955Medicaid