Individual
JESSICA KRISTEN PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
250 E SUPERIOR ST STE 4-2304, CHICAGO, IL 60611-2914
(312) 472-0436
(312) 695-5645
Mailing address
250 E SUPERIOR ST STE 4-2304, CHICAGO, IL 60611-2914
(312) 472-0436
(312) 695-5645
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
036151313
IL
2085R0202X
Diagnostic Radiology Physician
0444275
KS
390200000X
Student in an Organized Health Care Education/Training Program
9408415
KS
Other
Enumeration date
04/22/2014
Last updated
01/25/2021
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