Individual
MERRITT M PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CAA
Contact information
Practice address
705 RILEY HOSPITAL DR, INDIANAPOLIS, IN 46202-5109
(317) 944-9981
(317) 944-0282
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
75000190A
IN
367H00000X
Anesthesiologist Assistant
Primary
75000190A
IN
Other
Enumeration date
09/20/2024
Last updated
10/11/2024
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