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General NPI Number Information
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NPI Number | 1134817646
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Entity Type | Individual
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Provider Name | PETER ALEX SHIREMAN
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Gender | Male
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Dates
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Enumeration Date | 04/24/2023
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Last Update Date | 01/03/2025
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Provider Practice Location Address
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Address Line | 3105 FIELDS SOUTH DR
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City | CHAMPAIGN
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State | IL
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Zip | 61822-3743
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Country | US
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Telephone | 217-902-3937
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Fax | 217-902-7757
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Provider Business Mailing Address
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Address Line | N5988 ALEXANDER LN
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City | FOND DU LAC
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State | WI
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Zip | 54937-7106
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Country | US
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Telephone | 920-933-9962
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 147002009
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number |
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License Number State |
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