MEDICARE: MR. PETER LUKE BOCHNIAK II FNP-BC

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	363LF0000X	Family Nurse Practitioner	71013293A	IN

General Provider Information

NPI Number	:	1356052617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PETER LUKE BOCHNIAK II FNP-BC

Provider Business Mailing Address
First Line	:	PO BOX 781076
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48278-1076
Country	:	US
Telephone Number	:	317-528-4800
Fax Number	:	317-865-1479

Provider Business Practice Location Address
First Line	:	12750 SAINT FRANCIS DR STE 320
Second Line	:
City	:	CROWN POINT
State	:	IN
Zip	:	46307-0264
Country	:	US
Telephone Number	:	219-662-0077
Fax Number	:	219-662-9496

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

Provider Enumeration Date	:	12/07/2022
Last Update Date	:	03/04/2026

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