Individual
MR. PETER MATHEW LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
34700 VALLEY RD, ROGERS MEMORIAL HOSPITAL, OCONOMOWOC, WI 53066-4500
(262) 646-4411
Mailing address
34700 VALLEY RD, OCONOMOWOC, WI 53066-4500
(262) 646-4411
(262) 646-1049
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
312115020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31704700
—
WI
Enumeration date
09/07/2005
Last updated
10/13/2021
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