Provider Demographics
NPI:1215954292
Name:PETER SCUCCIMARRI, MD, FAAFP, PC
Entity type:Organization
Organization Name:PETER SCUCCIMARRI, MD, FAAFP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:SCUCCIMARRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-761-2900
Mailing Address - Street 1:3055 PLYMOUTH RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-3208
Mailing Address - Country:US
Mailing Address - Phone:734-761-2900
Mailing Address - Fax:734-761-5283
Practice Address - Street 1:3055 PLYMOUTH RD
Practice Address - Street 2:SUITE 107
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-3208
Practice Address - Country:US
Practice Address - Phone:734-761-2900
Practice Address - Fax:734-761-5283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301047163207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIA78024Medicare UPIN
MIOM55300Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER