Provider Demographics
NPI:1134112683
Name:FOOTE, PETER S (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:S
Last Name:FOOTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1684 N PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-2408
Mailing Address - Country:US
Mailing Address - Phone:414-271-2020
Mailing Address - Fax:414-272-3932
Practice Address - Street 1:1684 N PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-2408
Practice Address - Country:US
Practice Address - Phone:414-271-2020
Practice Address - Fax:414-272-3932
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI23046207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30547400Medicaid
WI181904017Medicare PIN
WI000168570Medicare PIN
B52849Medicare UPIN
WI30547400Medicaid