Healthcare Provider Details

I. General information

NPI: 1932299781
Provider Name (Legal Business Name): PETER NEWHOUSE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 08/03/2020
Certification Date: 08/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S US 131
THREE RIVERS MI
49093
US

IV. Provider business mailing address

5943 STADIUM DR SUITE 3
KALAMAZOO MI
49009-3016
US

V. Phone/Fax

Practice location:
  • Phone: 269-286-7070
  • Fax: 269-286-7071
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301047316
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: