Provider Demographics
NPI:1275621328
Name:CZAKO, PETER F (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:F
Last Name:CZAKO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1695 12 MILE RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-1200
Mailing Address - Country:US
Mailing Address - Phone:248-551-8180
Mailing Address - Fax:248-551-8181
Practice Address - Street 1:1695 12 MILE RD
Practice Address - Street 2:SUITE 220
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-1200
Practice Address - Country:US
Practice Address - Phone:248-551-8180
Practice Address - Fax:248-551-8181
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301051102208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2930287Medicaid
F53893Medicare UPIN
0F31499003Medicare ID - Type Unspecified