MEDICARE: PETER GEORGE MAVRELIS 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	207RG0100X	Gastroenterology Physician	01030831A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	110044491	OTHER	IN	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000085027	OTHER	IN	ANTHEM BC/BS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	9115389	OTHER	IL	ANTHEM BC/BS

General Provider Information

NPI Number	:	1326043597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER GEORGE MAVRELIS MD

Provider Business Mailing Address
First Line	:	7895 GRAND BLVD
Second Line	:
City	:	HOBART
State	:	IN
Zip	:	46342-6665
Country	:	US
Telephone Number	:	219-947-1910
Fax Number	:	219-758-5009

Provider Business Practice Location Address
First Line	:	7895 GRAND BLVD
Second Line	:
City	:	HOBART
State	:	IN
Zip	:	46342-6665
Country	:	US
Telephone Number	:	219-947-1910
Fax Number	:	219-758-5009

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

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	12/09/2022

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Directions to “ PETER GEORGE MAVRELIS MD” Practice Location

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