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NPI Code Detail

MEDICARE: PETER JAMES CORMIER MD

MEDICARE: PETER JAMES CORMIER 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
12085R0202XDiagnostic Radiology Physician81869WI
22085R0202XDiagnostic Radiology Physician036166224IL

General Provider Information

NPI Number : 1942707815
Entity Type Code : Individual
Provider Name (Legal Business Name) : PETER JAMES CORMIER MD
Provider Business Mailing Address
First Line : 2508 W CHICKADEE TRL
Second Line :
City : ROCKFORD
State : IL
Zip : 61107-1073
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2799 W GRAND BLVD
Second Line :
City : DETROIT
State : MI
Zip : 48202-2608
Country : US
Telephone Number : 313-916-2600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/09/2018
Last Update Date : 01/29/2026

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