Individual
JERALD MILES PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1275 LINDOKKEN RD STE 315, MOUNT HOREB, WI 53572-9701
(000) 000-0000
Mailing address
1275 LINDOKKEN RD, MOUNT HOREB, WI 53572-9701
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
64866
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
732880000
—
MN
Enumeration date
06/30/2006
Last updated
02/13/2022
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