Individual
MR. WILLIAM HARRELD PETERSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3420 ILLINOIS ST, USS TRANQUILITY MEDICAL CLINIC 1007, GREAT LAKES, IL 60088-5230
(847) 688-6755
Mailing address
1313 PINE GROVE AVE, ROUND LAKE BEACH, IL 60073-2152
(847) 688-6755
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2000-PA22
NM
Other
Enumeration date
03/24/2006
Last updated
07/08/2007
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