# DR. MICHAEL CHARLES PETERSEN

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

## Provider details

- **NPI number:** 1881798379
- **Gender:** Man
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208000000X | Pediatrics Physician | 2006027561 | MO | — |
| 2080P0204X | Pediatric Emergency Medicine (Pediatrics) Physician | Q2049 | TX | Yes |

## Other

- **Enumeration date:** 09/12/2006
- **Last updated:** 09/04/2019