Basic Information
| Provider Information | |||||||||
| NPI: | 1609803766 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CERMAK | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | UFP PHALEN VILLAGE CLINIC | ||||||||
| Address2: | 1414 MARYLAND AVENUE EAST | ||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6517723461 | ||||||||
| FaxNumber: | 6517722605 | ||||||||
| Practice Location | |||||||||
| Address1: | UFP PHALEN VILLAGE CLINIC | ||||||||
| Address2: | 1414 MARYLAND AVENUE EAST | ||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6517723461 | ||||||||
| FaxNumber: | 6517722605 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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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 | 207R00000X | 20653 | MN | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 04-02514 | 01 | MN | MEDICA CHOICE & PRIMARY | OTHER | 1000614 | 01 | MN | UCARE | OTHER | 31320300 | 05 | WI | MEDICAID | 1027633 | 01 | MN | ARAZ | OTHER | HP15990 | 01 | MN | HEALTHPARTNERS | OTHER | 04-02443 | 01 | MN | MEDICA | OTHER | 440385100 | 05 | MN | MEDICAID | 42G35CE | 01 | MN | BCBS | OTHER |