Provider Demographics
NPI:1962286096
Name:PETER CAPELLI MD S.C.
Entity type:Organization
Organization Name:PETER CAPELLI MD S.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:AJ
Authorized Official - Last Name:CAPELLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-843-4422
Mailing Address - Street 1:7137 236TH AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:WI
Mailing Address - Zip Code:53168-8975
Mailing Address - Country:US
Mailing Address - Phone:262-843-4422
Mailing Address - Fax:262-843-1166
Practice Address - Street 1:7137 236TH AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:SALEM
Practice Address - State:WI
Practice Address - Zip Code:53168-8975
Practice Address - Country:US
Practice Address - Phone:262-496-5602
Practice Address - Fax:262-843-1166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-21
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1184253197Medicaid