Provider Demographics
NPI:1326042060
Name:WINTERS, PETER LEE (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:LEE
Last Name:WINTERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13000 N MERIDIAN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-1404
Mailing Address - Country:US
Mailing Address - Phone:317-208-3813
Mailing Address - Fax:317-208-3815
Practice Address - Street 1:13000 N MERIDIAN ST STE 101
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-1404
Practice Address - Country:US
Practice Address - Phone:317-208-3813
Practice Address - Fax:317-208-3815
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-10
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01021996A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000084950OtherANTHEM
IN351521042OtherTIN
IN063040AMedicare PIN
INB28172Medicare UPIN