Individual
JOANNE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4735 W RIVER DR NE, COMSTOCK PARK, MI 49321-9607
(616) 784-9400
(616) 784-5167
Mailing address
4735 WEST RIVER DR NE, COMSTOCK PARK, MI 49321-9607
(616) 784-9400
(616) 784-5167
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
4301074292
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5214331
—
MI
Enumeration date
08/29/2006
Last updated
10/01/2007
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