Provider Demographics
NPI:1811970015
Name:SLISKOVICH, PETER D (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:D
Last Name:SLISKOVICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1600 S GAFFEY ST
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-4628
Mailing Address - Country:US
Mailing Address - Phone:310-548-0201
Mailing Address - Fax:310-547-3340
Practice Address - Street 1:1360 W 6TH ST
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732-3514
Practice Address - Country:US
Practice Address - Phone:310-833-2461
Practice Address - Fax:310-833-6342
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2022-01-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA133295207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA48952Medicare UPIN