Individual
KELLSEY PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2799 W GRAND BLVD, DETROIT, MI 48202-2608
(800) 653-6568
(313) 876-1305
Mailing address
1 FORD PL STE 3A, DETROIT, MI 48202-3450
(313) 874-4806
(313) 876-1305
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4301506898
MI
207RC0000X
Cardiovascular Disease Physician
Primary
4301506898
MI
208M00000X
Hospitalist Physician
303757
NY
Other
Enumeration date
04/20/2016
Last updated
09/19/2023
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