Healthcare Provider Details

I. General information

NPI: 1093785628
Provider Name (Legal Business Name): PETER M TURLO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1199 HADLEY RD STE 100
MOORESVILLE IN
46158-1788
US

IV. Provider business mailing address

PO BOX 781076
DETROIT MI
48278-1076
US

V. Phone/Fax

Practice location:
  • Phone: 317-834-3263
  • Fax: 317-834-5194
Mailing address:
  • Phone: 317-528-4800
  • Fax: 317-865-1479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01048971
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: