Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 4301052718 | MI |
NPI | 1023076866 |
---|---|
Provider Name | Dr. Peter Y Tseng |
First Address | Fort Gratiot, MI 48059-4086 |
Second Address | Port Huron, MI 48060-3511 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2006 |
Last Update Date | 05/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
102866032 | (05) | MI |
F34908 | (02) | MI |