Organization
MID AMERICA SENIOR MANAGEMENT ACO LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK PETERSEN MD (OWNER)
(913) 208-6221
Entity
Organization
Contact information
Practice address
21107 DONAHOO RD, TONGANOXIE, KS 66086-4153
(913) 742-4084
Mailing address
21107 DONAHOO RD, TONGANOXIE, KS 66086-4153
(913) 742-4084
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
05/30/2024
Last updated
05/30/2024
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