Individual
KEITH HERSHEL PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
400 E 3RD ST, ESSENTIA HEALTH DULUTH CLINIC, DULUTH, MN 55805-1951
(218) 786-4020
Mailing address
400 E 3RD ST, ESSENTIA HEALTH DULUTH CLINIC, DULUTH, MN 55805-1951
(218) 786-4020
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
49588
MN
207R00000X
Internal Medicine Physician
62724-20
WI
208000000X
Pediatrics Physician
49588
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1689718637
—
MN
Enumeration date
02/15/2007
Last updated
12/02/2015
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