Individual
PHILLIP K PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
516 DELAWARE STREET SE, UMP DELAWARE STREET CLINIC, MINNEAPOLIS, MN 55455
(612) 884-0649
Mailing address
720 WASHINGTON AVE SE, UNIVERSITY OF MINNESOTA PHYSICIANS, MINNEAPOLIS, MN 55414
(612) 884-0649
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
22228
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
112270300
—
MN
Enumeration date
06/10/2006
Last updated
10/31/2012
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