Individual
JAN E PETERSON II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2001 W 86TH ST, INDIANAPOLIS, IN 46260-1902
(317) 338-3634
Mailing address
10330 N MERIDIAN ST # 300, INDIANAPOLIS, IN 46290-1024
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01044172A
IN
207RN0300X
Nephrology Physician
01044172A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000381516
ANTHEM
IN
05
—
200052650
—
IN
Enumeration date
05/25/2006
Last updated
02/03/2017
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