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:
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Health care specialties

SpecialtyCodeLicense #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 4 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1306830377 NPPES
Wisconsin MEDICAID 31704700

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