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1245212893

NPI Code Detail

MEDICARE: PETER E SICES MD

MEDICARE: PETER E SICES MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	01053431A	IN
2	207R00000X	Internal Medicine Physician	4301098767	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4301099867	OTHER	MI	LICENSE
3	200479394	OTHER	IN	TAX IDENTIFICATION

General Provider Information

NPI Number	:	1245212893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER E SICES MD

Provider Business Mailing Address
First Line	:	36123 SCHOOLCRAFT
Second Line	:
City	:	LIVONIA
State	:	MI
Zip	:	48150-1216
Country	:	US
Telephone Number	:	734-793-6140
Fax Number	:

Provider Business Practice Location Address
First Line	:	235 WEALTHY ST SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503-5247
Country	:	US
Telephone Number	:	734-793-6140
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	02/18/2015

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Directions to “ PETER E SICES MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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