MEDICARE: DR. ANTHONY JOHN PELEZO M.D.

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	207P00000X	Emergency Medicine Physician	01060037A	IN

General Provider Information

NPI Number	:	1629342480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTHONY JOHN PELEZO M.D.

Provider Business Mailing Address
First Line	:	3231 WILLOW BEND TRL
Second Line	:
City	:	ZIONSVILLE
State	:	IN
Zip	:	46077-4412
Country	:	US
Telephone Number	:	314-368-6595
Fax Number	:

Provider Business Practice Location Address
First Line	:	3231 WILLOW BEND TRL
Second Line	:
City	:	ZIONSVILLE
State	:	IN
Zip	:	46077-4412
Country	:	US
Telephone Number	:	314-368-6595
Fax Number	:

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

Provider Enumeration Date	:	02/26/2012
Last Update Date	:	02/26/2012

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