Individual
TODD CHARLES PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
12499 UNIVERSITY AVE, CLIVE, IA 50325-8288
(515) 440-2676
Mailing address
12411 LINCOLN AVE, CLIVE, IA 50325-8126
(515) 440-2676
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
5101018316
MI
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
Primary
DO-04737
IA
Other
Enumeration date
07/02/2009
Last updated
08/07/2015
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