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NPI Code Detail

MEDICARE: PETER JAMES LY MD

MEDICARE: PETER JAMES LY 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
1207Q00000XFamily Medicine PhysicianA193415CA
2390200000XStudent in an Organized Health Care Education/Training Program
3207Q00000XFamily Medicine Physician4301505003MI

General Provider Information

NPI Number : 1356838494
Entity Type Code : Individual
Provider Name (Legal Business Name) : PETER JAMES LY MD
Provider Business Mailing Address
First Line : 32010 JEFFERSON AVE
Second Line :
City : SAINT CLAIR SHORES
State : MI
Zip : 48082-1365
Country : US
Telephone Number : 248-462-5821
Fax Number :
Provider Business Practice Location Address
First Line : 1900 S MAIN ST
Second Line :
City : FINDLAY
State : OH
Zip : 45840-1216
Country : US
Telephone Number : 419-423-4500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2018
Last Update Date : 05/20/2025

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