Individual
BRADY LEE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
2900 BRADFORD ST NE, GRAND RAPIDS, MI 49525-6427
(616) 885-5000
(616) 885-5020
Mailing address
100 MICHIGAN ST NE # MC845, GRAND RAPIDS, MI 49503-2560
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601004582
MI
Other
Enumeration date
06/27/2006
Last updated
02/25/2021
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