Individual
STACY PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
9000 W WISCONSIN AVE, MILWAUKEE, WI 53226-4874
(414) 266-3560
(414) 266-6092
Mailing address
9000 W WISCONSIN AVE, MILWAUKEE, WI 53226-4874
(414) 266-3560
(414) 266-6092
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
52973
WI
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
52973
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1356515704
—
WI
Enumeration date
04/16/2008
Last updated
03/13/2024
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