Individual
DR. MICHAEL GENE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
201 E. NICOLLET BLVD., BURNSVILLE, MN 55337
(612) 889-5480
Mailing address
5435 FELTL RD, MINNETONKA, MN 55343-7983
(952) 857-1504
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
4301085530
MI
207P00000X
Emergency Medicine Physician
Primary
52328
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1609079094
—
MN
01
—
207P00000X
PROVIDER TAXONOMY
—
01
—
52328
MN MEDICAL LICENSE
MN
Enumeration date
06/06/2007
Last updated
02/11/2010
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