Theut, Peter C

Theut, Peter C is an individual health care provider with primary practice located at 1111 Leffingwell Ave Ne Ste 100, Grand Rapids MI 49525-6406. He recently has only one registered license in Allopathic & Osteopathic Physicians / Sports Medicine, which is considered as his primary health care specialty. Theut, Peter C can be contacted via phone (616) 459-7101.

Contact Information

Primary practice address
1111 Leffingwell Ave Ne Ste 100 Grand Rapids MI 49525-6406
Phone: (616) 459-7101
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Sports Medicine 207XX0005X 4301063761 Michigan

Profile Details

NPI number 1720076219
LBN Legal business name Theut, Peter C
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 10th, 2005
Last updated Mar 12th, 2013 - about 11 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 1720076219 NPPES
Michigan MEDICAID 4216995

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