Provider Demographics
NPI:1265750152
Name:PETER, MICHAEL OTTO (MD)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:OTTO
Last Name:PETER
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:FRIEDLAENDERSTR. 23
Mailing Address - Street 2:
Mailing Address - City:OBERURSEL
Mailing Address - State:HESSEN
Mailing Address - Zip Code:61440
Mailing Address - Country:DE
Mailing Address - Phone:496171-204-3243
Mailing Address - Fax:496171-204-3244
Practice Address - Street 1:FRIEDLAENDERSTR. 2
Practice Address - Street 2:
Practice Address - City:OBERURSEL
Practice Address - State:HESSEN
Practice Address - Zip Code:61440
Practice Address - Country:DE
Practice Address - Phone:496171-204-3243
Practice Address - Fax:496171-204-3244
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-17
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA 525402084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry