Lake, Peter Mathew
Lake, Peter Mathew is an individual health care provider with primary practice located at 34700 Valley Rd Rogers Memorial Hospital, Oconomowoc WI 53066-4500. He recently has only one registered license in Allopathic & Osteopathic Physicians / Child & Adolescent Psychiatry, which is considered as his primary health care specialty. Lake, Peter Mathew can be contacted via phone (262) 646-4411.Contact Information
Primary practice address
34700 Valley Rd Rogers Memorial Hospital
Oconomowoc WI 53066-4500
Phone: (262) 646-4411
Fax:
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Allopathic & Osteopathic Physicians / Child & Adolescent Psychiatry | 2084P0804X | 312115020 | Wisconsin |
Profile Details
NPI number | 1306830377 |
---|---|
LBN Legal business name | Lake, Peter Mathew |
Credentials | Doctor of Medicine (MD) |
Entity | Individual |
Sole proprietor 1 | No |
Enumeration date | Sep 7th, 2005 |
Last updated | Oct 13th, 2021 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1306830377 | NPPES |
Wisconsin | MEDICAID | 31704700 |
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