Individual
DR. MARK THEODORE PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NAPRAPATH
Contact information
Practice address
5712 NEWBURG RD, ROCKFORD, IL 61108-6707
(815) 397-8840
Mailing address
5712 NEWBURG RD, ROCKFORD, IL 61108-6707
(815) 397-8840
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
IL
Other
Enumeration date
03/29/2007
Last updated
07/08/2007
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