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Individual

DALE R PETERSEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
2001 BLAISDELL AVE, PARK NICOLLET CLINIC MINNEAPOLIS, MINNEAPOLIS, MN 55404-2414
(952) 993-8000
Mailing address
6465 WAYZATA BLVD, STE 315, ST LOUIS PARK, MN 55426-1728
(952) 993-6450
(952) 993-0300

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
32723
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
728595700
MN
Enumeration date
11/30/2005
Last updated
10/20/2011
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