Individual
KELLY MALIA PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1301 MERCY DRIVE, MUSKEGON, MI 49444
(231) 739-9492
Mailing address
3621 S STATE ST, ANN ARBOR, MI 48108-1633
(734) 647-5299
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601007197
MI
Other
Enumeration date
09/11/2014
Last updated
08/05/2019
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