Individual
DR. MICHAEL J PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3922 MERCY DR, MCHENRY, IL 60050-3151
(815) 344-4499
Mailing address
3922 MERCY DR, MCHENRY, IL 60050-3151
(815) 344-4499
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016002938 1
—
IL
Enumeration date
08/02/2006
Last updated
07/08/2007
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