Individual
JANICE L PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
232 S MAIN ST, CULVER, IN 46511-1648
(574) 335-7780
(574) 335-0730
Mailing address
6989 STATE ROAD 17, PLYMOUTH, IN 46563-8701
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01038966A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201168800
—
IN
05
—
201168800A
—
IN
Enumeration date
05/24/2013
Last updated
05/22/2023
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