Healthcare Provider Details

I. General information

NPI: 1174708622
Provider Name (Legal Business Name): PETER D COTEY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2008
Last Update Date: 02/20/2020
Certification Date: 02/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LANSING VA CBOC 2025 S WASHINGTON AVE
LANSING MI
48910
US

IV. Provider business mailing address

9424 W SCENIC LAKE DR
LAINGSBURG MI
48848-9749
US

V. Phone/Fax

Practice location:
  • Phone: 517-267-3925
  • Fax: 517-267-3593
Mailing address:
  • Phone: 517-651-1403
  • Fax: 517-267-3593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101011399
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: