Provider Demographics
NPI:1184253197
Name:CAPELLI, PETER ALFRED JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:ALFRED JOHN
Last Name:CAPELLI
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 1:7137 236TH AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:WI
Mailing Address - Zip Code:53168-8975
Mailing Address - Country:US
Mailing Address - Phone:262-843-4422
Mailing Address - Fax:
Practice Address - Street 1:7137 236TH AVE STE 103
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:WI
Practice Address - Zip Code:53168-8975
Practice Address - Country:US
Practice Address - Phone:262-843-4422
Practice Address - Fax:262-843-1166
Is Sole Proprietor?:No
Enumeration Date:2020-04-02
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WI1184253197207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program