Provider Demographics
NPI:1912943275
Name:BITTERMAN, PETER BRUCE (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:BRUCE
Last Name:BITTERMAN
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 1:720 WASHINGTON AV SE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414
Mailing Address - Country:US
Mailing Address - Phone:612-884-0649
Mailing Address - Fax:612-676-8992
Practice Address - Street 1:UNIVERSITY OF MINNESOTA PHYSICIANS
Practice Address - Street 2:516 DELAWARE STREET SE, PWB SECOND FLOOR, CLINIC 2A
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-626-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN29523207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0500876Medicaid
MN768024OtherARAZ
MN2T129BIOtherBCBS
MN1008984OtherPREFERRED ONE
MN182077000Medicaid
WI30705900Medicaid
MN100815OtherUCARE
ND10387Medicaid
MN48-00006OtherMEDICA PRIMARY
MN48-00209OtherMEDICA CHOICE
SD7777470Medicaid
MNHP22241OtherHEALTHPARTNERS
MN48-00209OtherMEDICA CHOICE
MN182077000Medicaid
ND10387Medicaid