Individual
DR. CHERYL S PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2797 PRAIRIE AVE, SUITE 26, BELOIT, WI 53511-2288
(815) 714-8030
Mailing address
2797 PRAIRIE AVE, SUITE 26, BELOIT, WI 53511-2288
(815) 714-8030
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
036-080979
IL
207Q00000X
Family Medicine Physician
Primary
31236020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31600400
—
WI
01
—
553180
MEDICARE GROUP #
IL
01
—
834340
MEDICARE GROUP #
IL
Enumeration date
10/02/2006
Last updated
10/20/2023
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