Basic Information
| Provider Information | |||||||||
| NPI: | 1104145200 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PEACOCK | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | DOUGLAS | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1500 E. MEDICAL CENTER DRIVE | ||||||||
| Address2: | B1-380 TC | ||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481095305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347637919 | ||||||||
| FaxNumber: | 7347639298 | ||||||||
| Practice Location | |||||||||
| Address1: | 1500 E. MEDICAL CENTER DRIVE | ||||||||
| Address2: | B1-380 TC | ||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481095305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347637919 | ||||||||
| FaxNumber: | 7347639298 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2010 | ||||||||
| LastUpdateDate: | 08/22/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | MI | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207P00000X | 4301096679 | MI | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.