MEDICARE: DANIEL E PETERY

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	171WH0202X	Home Modifications Contractor

General Provider Information

NPI Number	:	1356521785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL E PETERY

Provider Business Mailing Address
First Line	:	1420 AUBURN AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44113-5231
Country	:	US
Telephone Number	:	216-685-1595
Fax Number	:	216-685-1605

Provider Business Practice Location Address
First Line	:	1420 AUBURN AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44113-5231
Country	:	US
Telephone Number	:	216-685-1595
Fax Number	:	216-685-1605

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

Provider Enumeration Date	:	11/14/2007
Last Update Date	:	11/14/2007

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Directions to “ DANIEL E PETERY ” Practice Location

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