Physician Compare National (NPI:1528094414)

HEALTHCARE PROVIDER: DR. PETER MICHALOS

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1528094414
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6406768712
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20110315000137
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MICHALOS
	Individual professional last name
Provider First Name	PETER
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	STATE UNIVERSITY OF NEW YORK DOWNSTATE MEDICAL CENTER
	Individual professional's medical school
Graduation Year	1986
	Individual professional's medical school graduation year
Primary Specialty	OPHTHALMOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	PLASTIC AND RECONSTRUCTIVE SURGERY
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	PLASTIC AND RECONSTRUCTIVE SURGERY
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	67 HAMPTON RD
	Group Practice or individual's line 1 address
Line 2 Street Address	UNIT 102
	Group Practice or individual's line 2 address
City	SOUTHAMPTON
	Group Practice or individual's city
State	NY
	Group Practice or individual's state
Zip Code	119684962
	Group Practice or individual's zip code (9 digits when available)
Phone Number	6312833222
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	330393
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	SUNY/STONY BROOK UNIVERSITY HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y