Healthcare Provider Details

I. General information

NPI: 1821041278
Provider Name (Legal Business Name): PETER M DELNEKY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 01/12/2021
Certification Date: 01/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1122 PROFESSIONAL DR
GOSHEN IN
46526-3819
US

IV. Provider business mailing address

1122 PROFESSIONAL DR
GOSHEN IN
46526-3819
US

V. Phone/Fax

Practice location:
  • Phone: 574-533-0560
  • Fax: 574-533-1716
Mailing address:
  • Phone: 574-533-0560
  • Fax: 574-533-1716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD428083
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number01065141A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: