Provider Demographics
NPI:1023157278
Name:TOTHY, PETER K (MD)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:K
Last Name:TOTHY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:342 E 109TH AVE
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-8693
Mailing Address - Country:US
Mailing Address - Phone:219-310-2550
Mailing Address - Fax:219-310-2565
Practice Address - Street 1:342 E 109TH AVE
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-8693
Practice Address - Country:US
Practice Address - Phone:219-310-2550
Practice Address - Fax:219-310-2565
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01065693A207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200911390Medicaid
IN218800TMedicare PIN
IN200911390Medicaid