Individual
DR. MARK IRWIN PETERSEN
Active
Individual
DR. MARK IRWIN PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
04-21601
KS
207R00000X
Internal Medicine Physician
Primary
0421601
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100135660B
—
KS
01
—
13217089
BCBS
—
01
—
2050317102
RAILROAD MEDICARE
—
Enumeration date
05/17/2006
Last updated
10/08/2024
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