MEDICARE: JAMES L PETERS M.D.

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	207Q00000X	Family Medicine Physician	01026337A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00459131	OTHER	IN	RAILROAD MEDICARE PIN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821091935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES L PETERS M.D.

Provider Business Mailing Address
First Line	:	30 W RAMPART ST
Second Line	:	STE 210
City	:	SHELBYVILLE
State	:	IN
Zip	:	46176-8897
Country	:	US
Telephone Number	:	317-398-0121
Fax Number	:	317-398-2335

Provider Business Practice Location Address
First Line	:	30 W RAMPART ST
Second Line	:	STE 210
City	:	SHELBYVILLE
State	:	IN
Zip	:	46176-8897
Country	:	US
Telephone Number	:	317-398-0121
Fax Number	:	317-398-2335

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	01/14/2014

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