Provider Demographics
NPI:1134817646
Name:SHIREMAN, PETER ALEX
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:ALEX
Last Name:SHIREMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N5988 ALEXANDER LN
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54937-7106
Mailing Address - Country:US
Mailing Address - Phone:920-933-9962
Mailing Address - Fax:
Practice Address - Street 1:3105 FIELDS SOUTH DR
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822-3743
Practice Address - Country:US
Practice Address - Phone:217-902-3937
Practice Address - Fax:217-902-7757
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147002009231H00000X
231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist