Individual
BRADFORD G PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
12251 S 80TH AVE, PALOS COMMUNITY HOSPITAL, PALOS HEIGHTS, IL 60463-1256
(708) 923-5700
(708) 923-8848
Mailing address
PO BOX 239D, PARK RIDGE, IL 60068-8018
(847) 759-1560
(847) 803-1006
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
036093195
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036093195
—
IL
01
—
050046667
RR MEDICARE
IL
Enumeration date
01/23/2006
Last updated
07/12/2021
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