MEDICARE: DR. MIMI I PEAK M.D, M.P.H.

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	2083A0100X	Aerospace Medicine Physician	0101055670	VA
2	2083X0100X	Occupational Medicine Physician	0101055670	VA

General Provider Information

NPI Number	:	1821061276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MIMI I PEAK M.D, M.P.H.

Provider Business Mailing Address
First Line	:	30 MILFORD RD
Second Line	:
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23601-3938
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	515 STERNBERG AVE
Second Line	:	MACDONALD ARMY COMMUNITY HOSPITAL
City	:	FORT EUSTIS
State	:	VA
Zip	:	23604-1526
Country	:	US
Telephone Number	:	757-314-7613
Fax Number	:

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

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	09/27/2007

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