Individual
WAYNE W. PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
240 MAPLE AVE, MUKWONAGO, WI 53149-8475
(262) 928-1900
Mailing address
240 MAPLE AVE, MUKWONAGO, WI 53419-8475
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
27301
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30695400
—
WI
Enumeration date
02/09/2006
Last updated
10/19/2007
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