# DR. DANIEL S PETERSEN

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1578049763
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 125.073406 | IL | — |
| 207QS1201X | Sleep Medicine (Family Medicine) Physician | 77190-20 | WI | Yes |

## Other

- **Enumeration date:** 07/11/2018
- **Last updated:** 08/03/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1578049763 | — | WI |