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NPI Code Detail

MEDICARE: PETER A WALLSKOG MD

MEDICARE: PETER A WALLSKOG 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
1207R00000XInternal Medicine PhysicianDR.0054454CO
2208M00000XHospitalist PhysicianDR.0054454CO

General Provider Information

NPI Number : 1588655096
Entity Type Code : Individual
Provider Name (Legal Business Name) : PETER A WALLSKOG MD
Provider Business Mailing Address
First Line : 2637 MIDPOINT DR STE B
Second Line :
City : FORT COLLINS
State : CO
Zip : 80525-4408
Country : US
Telephone Number : 970-488-1666
Fax Number :
Provider Business Practice Location Address
First Line : 2637 MIDPOINT DR STE B
Second Line :
City : FORT COLLINS
State : CO
Zip : 80525-4408
Country : US
Telephone Number : 970-488-1666
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/03/2005
Last Update Date : 11/04/2019

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Directions to “ PETER A WALLSKOG MD” Practice Location

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