Individual
DR. MICHAEL CHARLES PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
12356 RIATA TRACE PKWY # 6006-B, AUSTIN, TX 78727-6417
(512) 506-7000
(314) 251-4450
Mailing address
12356 RIATA TRACE PKWY # 6006-B, AUSTIN, TX 78727-6417
(512) 506-7000
(314) 251-4450
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
2006027561
MO
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
Primary
Q2049
TX
Other
Enumeration date
09/12/2006
Last updated
09/04/2019
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