Individual
DR. TARA PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
9000 W WISCONSIN AVE, MS 681, MILWAUKEE, WI 53226-4874
(414) 266-3360
(414) 266-3563
Mailing address
9000 W WISCONSIN AVE, MS 681, MILWAUKEE, WI 53226-4874
(414) 266-3360
(414) 266-3563
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
MT189036
PA
2080P0203X
Pediatric Critical Care Medicine Physician
Primary
61162
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1427255785
—
WI
Enumeration date
06/29/2007
Last updated
12/02/2019
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