Individual
KYLE S PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
5700 S MARYLAND AVE, CHICAGO, IL 60637-1426
(773) 702-3222
Mailing address
1845 S MICHIGAN AVE UNIT 1510, CHICAGO, IL 60616-2497
(815) 260-4322
Taxonomy
Speciality
Code
Description
License number
State
163WF0300X
Flight Registered Nurse
Primary
041411744
IL
Other
Enumeration date
03/26/2020
Last updated
04/10/2020
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