Provider Demographics
NPI:1902937550
Name:PETER P. MCKELLAR MD, PC
Entity Type:Organization
Organization Name:PETER P. MCKELLAR MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKELLAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-239-4335
Mailing Address - Street 1:1111 E MCDOWELL RD
Mailing Address - Street 2:DEPARTMENT OF MEDICINE
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2612
Mailing Address - Country:US
Mailing Address - Phone:602-239-4335
Mailing Address - Fax:602-239-2084
Practice Address - Street 1:1111 E MCDOWELL RD
Practice Address - Street 2:DEPARTMENT OF MEDICINE
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2612
Practice Address - Country:US
Practice Address - Phone:602-239-4335
Practice Address - Fax:602-239-2084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10012207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZE34943Medicare UPIN