Doctor Name: | MR. PETER GRANT CLEVELAND |
NPI Number: | 1033445457 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 19831-20 |
Business Practice Address: | E11380 Ski-hi Road Baraboo, WI - 53913 |
Business Phone Number: | 6083567372 |
Business Fax Number: | |
Mailing Address: | E11380 Ski-hi Road, BARABOO |
State: | WI |
Postal Code: | 53913 |
Phone Number: | 6083567372 |
Fax Number: | |
NPI Enumeration Date: | 10/20/2009 |
NPI Last Update Date: | 10/20/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 19831-20 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |