Provider Demographics
NPI:1750373759
Name:ROSSI, PETER I (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:I
Last Name:ROSSI
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:P.O. BOX 6002
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61803-6002
Mailing Address - Country:US
Mailing Address - Phone:217-326-8300
Mailing Address - Fax:260-373-4167
Practice Address - Street 1:85 E US HIGHWAY 6 STE 310
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-8948
Practice Address - Country:US
Practice Address - Phone:219-983-6380
Practice Address - Fax:219-983-6080
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01056380A208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00229183OtherRAIL ROAD MEDICARE #
IN200380940Medicaid
ILIL3270135Medicare PIN
IN200380940Medicaid
IN046240KMedicare ID - Type Unspecified
INP00229183OtherRAIL ROAD MEDICARE #
ING53925Medicare UPIN