Individual
DR. KYLE S. PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
1110 W SCHICK RD, BARTLETT, IL 60103-3007
(630) 372-1100
(630) 483-0852
Mailing address
1110 W SCHICK RD, BARTLETT, IL 60103-3007
(630) 372-1100
(614) 895-8810
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
016005623
IL
213ES0103X
Foot & Ankle Surgery Podiatrist
36003642
OH
213ES0103X
Foot & Ankle Surgery Podiatrist
SC006240
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SC006240
STATE PODIATRIC LICENSE NUMBER
PA
Enumeration date
03/19/2011
Last updated
11/04/2019
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