Healthcare Provider Details

I. General information

NPI: 1356722409
Provider Name (Legal Business Name): PETER M WALLENHORST M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2015
Last Update Date: 09/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY OF KENTUCKY 800 ROSE STREET
LEXINGTON KY
40536
US

IV. Provider business mailing address

UK GENERAL INTERNAL MEDICINE 900 S LIMESTONE ROOM 306
LEXINGTON KY
40536-0200
US

V. Phone/Fax

Practice location:
  • Phone: 859-257-1000
  • Fax:
Mailing address:
  • Phone: 859-323-6642
  • Fax: 859-323-1200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number51615
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number51615
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: