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Individual

MICHAEL JAKE PETERSEN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
3800 MONTLAKE BLVD, SEATTLE, WA 98195-0007
(206) 520-5000
Mailing address
2516 STOCKTON BLVD, SACRAMENTO, CA 95817-2208

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
A191321
CA
2080S0010X
Pediatric Sports Medicine Physician
Primary
MD.MD.61679347
WA

Other

Enumeration date
04/30/2019
Last updated
04/11/2026
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