Individual
ISAAC PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
12908 FERRIS AVE, CLEVELAND, OH 44105-5553
(216) 201-1063
Mailing address
12908 FERRIS AVE, CLEVELAND, OH 44105-5553
(216) 201-1063
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0245260
—
OH
Enumeration date
11/25/2020
Last updated
11/25/2020
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