Healthcare Provider Details

I. General information

NPI: 1548171622
Provider Name (Legal Business Name): PETER AUGUSTINE SEMATIKO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2641 15TH ST S APT 18
FARGO ND
58103-6943
US

IV. Provider business mailing address

2641 15TH ST S APT 18
FARGO ND
58103-6943
US

V. Phone/Fax

Practice location:
  • Phone: 701-540-3432
  • Fax:
Mailing address:
  • Phone: 701-540-3432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number273ETS
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: