Healthcare Provider Details

I. General information

NPI: 1518965912
Provider Name (Legal Business Name): PETER WILLIAM PICK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2005
Last Update Date: 07/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 WEISS STREET MEDICAL SERVICE-NEUROLOGY 111, VAMC
SAGINAW MI
48602
US

IV. Provider business mailing address

1500 WEISS STREET MEDICAL SERVICE-NEUROLOGY 111, VAMC
SAGINAW MI
48602
US

V. Phone/Fax

Practice location:
  • Phone: 414-510-8454
  • Fax:
Mailing address:
  • Phone: 414-510-8454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZN0500X
TaxonomyNeuropathology Physician
License Number40043
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number40043
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number40043
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: