MEDICARE: PETER R PAUL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	4301063025	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407853617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER R PAUL MD

Provider Business Mailing Address
First Line	:	2200 GREEN RD
Second Line	:	SUITE B
City	:	ANN ARBOR
State	:	MI
Zip	:	48105
Country	:	US
Telephone Number	:	734-994-7446
Fax Number	:	734-623-8590

Provider Business Practice Location Address
First Line	:	2200 GREEN RD
Second Line	:	SUITE B
City	:	ANN ARBOR
State	:	MI
Zip	:	48105
Country	:	US
Telephone Number	:	734-994-7446
Fax Number	:	734-623-8590

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	06/08/2026

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