Individual
LISA M PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
945 N 12TH ST, MILWAUKEE, WI 53233-1305
(414) 219-7370
(414) 219-7967
Mailing address
945 N 12TH ST, MILWAUKEE, WI 53233-1305
(414) 219-7370
(414) 219-7967
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
42769
WI
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
Primary
42769-21
WI
207RN0300X
Nephrology Physician
42769
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
43548700
—
WI
Enumeration date
08/19/2005
Last updated
07/09/2022
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