Provider Demographics
NPI:1972566487
Name:WILLIAM J PETERS DPM,PC
Entity Type:Organization
Organization Name:WILLIAM J PETERS DPM,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:313-278-5444
Mailing Address - Street 1:23100 CHERRY HILL ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-1449
Mailing Address - Country:US
Mailing Address - Phone:313-278-5444
Mailing Address - Fax:313-278-4800
Practice Address - Street 1:23100 CHERRY HILL ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-1493
Practice Address - Country:US
Practice Address - Phone:313-278-5444
Practice Address - Fax:313-278-4800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901000724213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4858210820OtherBCBSM
MI4858210820OtherBCBSM
MI0N82930Medicare ID - Type Unspecified