Healthcare Provider Details

I. General information

NPI: 1538614441
Provider Name (Legal Business Name): PETER G DOUKAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2016
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10191 BROADWAY STE 200
CROWN POINT IN
46307-8801
US

IV. Provider business mailing address

10191 BROADWAY STE 200
CROWN POINT IN
46307-8801
US

V. Phone/Fax

Practice location:
  • Phone: 219-924-8178
  • Fax: 219-924-8179
Mailing address:
  • Phone: 219-924-8178
  • Fax: 219-924-8179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125.075562
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number01100190A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: