Provider Demographics
NPI:1912960782
Name:MIDGLEY, PETER M (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:M
Last Name:MIDGLEY
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Gender:M
Credentials:MD
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Mailing Address - Street 1:5616 WOODDALE AVE
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55424-1628
Mailing Address - Country:US
Mailing Address - Phone:952-929-4704
Mailing Address - Fax:952-929-4705
Practice Address - Street 1:69 EXCHANGE ST W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-1004
Practice Address - Country:US
Practice Address - Phone:651-232-3348
Practice Address - Fax:651-232-3539
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MN46256207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNB37336Medicare UPIN