Individual
DR. JON FREDRICK PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1750 E LAKE SHORE DR, DECATUR, IL 62521-3803
(217) 464-1440
(217) 464-1469
Mailing address
1750 E LAKE SHORE DR, DECATUR, IL 62521-3803
(217) 464-1440
(217) 464-1469
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
036129728
IL
2083X0100X
Occupational Medicine Physician
Primary
036129728
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
250766
HEALTHLINK
—
Enumeration date
10/03/2005
Last updated
10/12/2016
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