Individual
ANTHONY PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2155 CITY GATE LN STE 225, NAPERVILLE, IL 60563
(630) 547-5040
Mailing address
PO BOX 713260, CHICAGO, IL 60677-1260
(630) 469-9200
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
036113202
IL
207R00000X
Internal Medicine Physician
036113202
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036113202
—
IL
Enumeration date
06/11/2007
Last updated
08/29/2023
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