Provider Demographics
NPI:1720248958
Name:IHLE, PETER MANDELERT (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:MANDELERT
Last Name:IHLE
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 1:9891 DEWITZ RD
Mailing Address - Street 2:
Mailing Address - City:FALL CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:54742-9384
Mailing Address - Country:US
Mailing Address - Phone:715-877-1514
Mailing Address - Fax:715-877-3615
Practice Address - Street 1:9891 DEWITZ RD
Practice Address - Street 2:
Practice Address - City:FALL CREEK
Practice Address - State:WI
Practice Address - Zip Code:54742-9384
Practice Address - Country:US
Practice Address - Phone:715-877-1514
Practice Address - Fax:715-877-3615
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16442-020174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist