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Individual
KEVIN A PETERSON
Active
Individual
KEVIN A PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
31945
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01-00482
MEDICA CHOICE
MN
01
—
1008691
PREFERRED ONE
MN
01
—
102872
UCARE
MN
05
—
267390800
—
MN
01
—
55D00PE
BLUE CROSS BLUE SHIELD
MN
01
—
768302
ARAZ
MN
01
—
HP16946
HEALTH PARTNERS
MN
Enumeration date
10/24/2006
Last updated
01/28/2013
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