Individual
MARY KATHRYN PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
205 S NORTHWEST HWY STE 130, PARK RIDGE, IL 60068-5802
(847) 292-5200
Mailing address
205 S NORTHWEST HWY STE 130, PARK RIDGE, IL 60068-5802
(847) 292-5200
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036121820
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036121820
—
IL
Enumeration date
05/22/2008
Last updated
10/12/2020
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