Individual
JEFFREY CARL PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, PHD
Contact information
Practice address
820 S WOOD ST STE 100, CHICAGO, IL 60612-4325
(312) 996-2933
Mailing address
820 S WOOD ST STE 100, CHICAGO, IL 60612-4325
(312) 996-2933
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
1013653591
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/09/2022
Last updated
08/26/2022
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