Organization
CAROL E. PETERSON, MD PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. HEATHER RYAN BOEREMA CPC (PATIENT ACCOUNTS MANAGER)
(231) 757-1260
Entity
Organization
Contact information
Practice address
6050 N US HIGHWAY 31, FREE SOIL, MI 49411-9157
(231) 757-1260
(231) 757-1261
Mailing address
6050 N US HIGHWAY 31, FREE SOIL, MI 49411-9157
(231) 757-1260
(231) 757-1261
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
4301050870
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0531035
BLUE CROSS BLUS SHIELD
MI
05
—
4831985
—
MI
Enumeration date
10/22/2007
Last updated
02/14/2008
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