Provider Demographics
NPI:1891788113
Name:SLOCUM, PETER A (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:A
Last Name:SLOCUM
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Gender:M
Credentials:MD
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Mailing Address - Street 1:788 N JEFFERSON ST
Mailing Address - Street 2:SUITE 300/ATTN. KAAREN BUTZEN
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-3718
Mailing Address - Country:US
Mailing Address - Phone:414-272-8950
Mailing Address - Fax:414-272-0859
Practice Address - Street 1:2350 N LAKE DR
Practice Address - Street 2:SUITE 306
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-4528
Practice Address - Country:US
Practice Address - Phone:414-298-7106
Practice Address - Fax:414-298-7195
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2016-11-09
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Provider Licenses
StateLicense IDTaxonomies
WI29305208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1891788113Medicaid
WI1891788113Medicaid
WI462100041Medicare PIN
WI1900040OtherUNITED HEALTHCARE
WI462100041Medicare PIN