Provider Demographics
NPI:1063540599
Name:MICHAELSON, PETER JOHN (DO)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:JOHN
Last Name:MICHAELSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:PETER
Other - Middle Name:JOHN
Other - Last Name:ADLER-MICHAELSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:6400 HEAD RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28409-2220
Mailing Address - Country:US
Mailing Address - Phone:910-616-8907
Mailing Address - Fax:
Practice Address - Street 1:2029 S 17TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-6600
Practice Address - Country:US
Practice Address - Phone:910-798-6500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM