Provider Demographics
NPI:1386607877
Name:PETERS, WILLIAM JOHN (DPM)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JOHN
Last Name:PETERS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23100 CHERRY HILL ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-1493
Mailing Address - Country:US
Mailing Address - Phone:313-278-5444
Mailing Address - Fax:313-278-4800
Practice Address - Street 1:23100 CHERRY HILL ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-1493
Practice Address - Country:US
Practice Address - Phone:313-278-5444
Practice Address - Fax:313-278-4800
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2010-01-29
Deactivation Date:2006-04-07
Deactivation Code:
Reactivation Date:2007-07-23
Provider Licenses
StateLicense IDTaxonomies
MI5901000724213E00000X
FLP0790213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4858210820OtherBLUE CROSS BLUE SHIELD
MI480H234160OtherBCBSM
MI4858210820OtherBLUE CROSS BLUE SHIELD
MI0N82930Medicare ID - Type Unspecified