Healthcare Provider Details

I. General information

NPI: 1356332076
Provider Name (Legal Business Name): PETER A SILKOWSKI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 02/26/2024
Certification Date: 02/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 WEATHERBY DR
CLARKSVILLE TN
37043-2408
US

IV. Provider business mailing address

809 WEATHERBY DR
CLARKSVILLE TN
37043-2408
US

V. Phone/Fax

Practice location:
  • Phone: 931-368-0018
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0832
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: