Individual
THOMAS PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
100 MICHIGAN ST NE, GRAND RAPIDS, MI 49503-2560
(616) 988-8220
Mailing address
4100 EMBASSY DR SE STE 400, GRAND RAPIDS, MI 49546-2416
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
4301105698
MI
207P00000X
Emergency Medicine Physician
Primary
4301105698
MI
Other
Enumeration date
06/04/2014
Last updated
01/22/2025
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