Individual
KARINA M PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
6900 N PORT WASHINGTON RD, MILWAUKEE, WI 53217-3921
(414) 270-8100
Mailing address
4425 N PORT WASHINGTON RD, ATTN: CSMCP CLINIC CREDENTIALING, GLENDALE, WI 53212-1082
(414) 270-8100
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
41434
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34046300
—
WI
Enumeration date
06/10/2006
Last updated
05/31/2011
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