Individual
MARK P PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5165 MCCARTY LN, LAFAYETTE, IN 47905-8764
(765) 448-8000
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
01096337A
IN
207L00000X
Anesthesiology Physician
4757
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
68935
—
MT
Enumeration date
09/26/2006
Last updated
07/16/2025
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