Individual
KEVIN A PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2001 BLOOMINGTON AVE, MINNEAPOLIS, MN 55404-3074
(612) 638-0700
(612) 627-4205
Mailing address
420 DELAWARE ST SE, UNIVERSITY OF MINNESOTA PHYSICIANS, MINNEAPOLIS, MN 55455-0341
(651) 772-3461
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
31945
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01-00482
MEDICA CHOICE
MN
01
—
1008691
PREFERRED ONE
MN
01
—
102872
UCARE
MN
05
—
267390800
—
MN
01
—
55D00PE
BLUE CROSS BLUE SHIELD
MN
01
—
768302
ARAZ
MN
01
—
HP16946
HEALTH PARTNERS
MN
Enumeration date
10/24/2006
Last updated
01/28/2013
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