Individual
BRENT H PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1345 RYAN PKWY, ALGONQUIN, IL 60102-4530
(847) 658-9555
(847) 658-2167
Mailing address
350 SURRYSE RD, SUITE 100, LAKE ZURICH, IL 60047-2313
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036075837
IL
Other
Enumeration date
09/01/2005
Last updated
12/15/2021
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