Individual
MICHAEL C PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
LHPG MENTOR FAMILY PRACTICE, 8655 MARKET STREET, MENTOR, OH 44060
(440) 255-7938
(440) 255-9196
Mailing address
8655 MARKET STREET, MENTOR, OH 44060-9404
(440) 255-7938
(440) 255-9196
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50002538
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50.002538
OHIO LICENSE
OH
Enumeration date
01/11/2007
Last updated
03/01/2021
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