Individual
DR. MICHAEL R PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2000 N HURON RIVER DR STE 100, YPSILANTI, MI 48197
(734) 572-1200
(734) 572-9760
Mailing address
39650 ORCHARD HILL PL STE 200, NOVI, MI 48375-5391
(248) 319-0161
(248) 319-0170
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
35-06-3107
OH
207WX0107X
Retina Specialist (Ophthalmology) Physician
Primary
4301406847
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000021228
BCBS
—
05
—
0886528
—
OH
05
—
100374400
—
IN
01
—
180026057
RAIL ROAD MEDICARE
OH
05
—
64930167
—
KY
Enumeration date
06/28/2006
Last updated
08/04/2020
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