Individual
LAURA PECK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5300 MEMORIAL DR, TWO RIVERS, WI 54241-3923
(920) 793-7300
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
5101025446
MI
208600000X
Surgery Physician
TL.005462
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100308760
—
WI
Enumeration date
07/09/2015
Last updated
04/30/2025
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