Basic Information
| Provider Information | |||||||||
| NPI: | 1750373759 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROSSI | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | I | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 6002 | ||||||||
| Address2: | |||||||||
| City: | URBANA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 618036002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2173268300 | ||||||||
| FaxNumber: | 2603734167 | ||||||||
| Practice Location | |||||||||
| Address1: | 85 E US HIGHWAY 6 STE 310 | ||||||||
| Address2: | |||||||||
| City: | VALPARAISO | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463838948 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2199836380 | ||||||||
| FaxNumber: | 2199836080 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2005 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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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 | 208G00000X | 01056380A | IN | Y | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
ID Information
| ID | Type | State | Issuer | Description | P00229183 | 01 | IN | RAIL ROAD MEDICARE # | OTHER | 200380940 | 05 | IN | MEDICAID |