Healthcare Provider Details

I. General information

NPI: 1780857508
Provider Name (Legal Business Name): EMARCIA PATRICE PEETE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2008
Last Update Date: 11/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 PRAIRIE AVE
BELOIT WI
53511-1844
US

IV. Provider business mailing address

2519 GALAHAD WAY
JANESVILLE WI
53548-1499
US

V. Phone/Fax

Practice location:
  • Phone: 608-363-5500
  • Fax:
Mailing address:
  • Phone: 608-352-7009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number002010
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number53592
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: