MEDICARE: PETER J HILLSAMER M.D.

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	207Y00000X	Otolaryngology Physician	01038246A	IN
2	207YX0905X	Otolaryngology/Facial Plastic Surgery Physician	01038246A	IN

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

General Provider Information

NPI Number	:	1316026545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER J HILLSAMER M.D.

Provider Business Mailing Address
First Line	:	6725 STACEY HOLLOW WAY
Second Line	:
City	:	LAFAYETTE
State	:	IN
Zip	:	47905-7544
Country	:	US
Telephone Number	:	765-589-9111
Fax Number	:

Provider Business Practice Location Address
First Line	:	6725 STACEY HOLLOW WAY
Second Line	:
City	:	LAFAYETTE
State	:	IN
Zip	:	47905-7544
Country	:	US
Telephone Number	:	765-589-9111
Fax Number	:

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

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	06/22/2026

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