Individual
DR. KENNETH WENDELL PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
2820 E ROCK HAVEN RD, SUITE # 120, HARRISONVILLE, MO 64701-4411
(816) 380-7662
Mailing address
2800 E ROCK HAVEN RD, HARRISONVILLE, MO 64701-4411
(816) 380-3474
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
05-33327
KS
207X00000X
Orthopaedic Surgery Physician
Primary
2013002819
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200570110A
—
KS
Enumeration date
04/23/2008
Last updated
10/08/2014
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