Peter Mathew Lake, MD

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

312115020 Issued in WI

Practice address

34700 Valley Rd
Rogers Memorial Hospital
Oconomowoc, WI 53066-4500

Phone

(262) 646-4411

NPI assigned

Sep 7, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1126051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634083200000",
    "number": "1306830377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34700 VALLEY RD",
            "city": "OCONOMOWOC",
            "state": "WI",
            "postal_code": "530664500",
            "telephone_number": "262-646-4411",
            "fax_number": "262-646-1049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34700 VALLEY RD",
            "address_2": "ROGERS MEMORIAL HOSPITAL",
            "city": "OCONOMOWOC",
            "state": "WI",
            "postal_code": "530664500",
            "telephone_number": "262-646-4411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAKE",
        "first_name": "PETER",
        "middle_name": "MATHEW",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-07",
        "last_updated": "2021-10-13",
        "certification_date": "2021-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "WI",
            "license": "312115020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31704700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lake Country Endoscopy Center, LLC
• Lake Country Pain Treatment
• Lake Country Pediatrics SC
• Lake Country Pharmacy
• Lake Country Private Medical, S.C.
• Lakeland Family Dental, LLC
• Jody Alice Langford, M.D.
• Mackenzie Elizabeth Larsen, DC
• Barbara Ann Larson, PT
• Kaitlyn E Laundre

• Child & Adolescent Psychiatry Physician in Oconomowoc, WI
• Providers in Oconomowoc, WI by specialty
• Child & Adolescent Psychiatry Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.