Healthcare Provider Details

I. General information

NPI: 1225065063
Provider Name (Legal Business Name): PETER R SCHOEPS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 11/17/2020
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32756 GRAND RIVER AVE
FARMINGTON MI
48336-3133
US

IV. Provider business mailing address

26901 BEAUMONT BLVD STE 3D
SOUTHFIELD MI
48033-3849
US

V. Phone/Fax

Practice location:
  • Phone: 248-476-3280
  • Fax: 248-476-3286
Mailing address:
  • Phone: 947-522-1863
  • Fax: 47-522-0307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number5101008985
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101008985
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number5101008985
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: