Individual
KENNETH D PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1111 LIGHTHOUSE LANE, GOSHEN, IN 46526-3824
(574) 533-0348
(574) 533-0277
Mailing address
1111 LIGHTHOUSE LANE, GOSHEN, IN 46526-3824
(574) 533-0348
(574) 533-0277
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
01028273
IN
Other
Enumeration date
09/07/2005
Last updated
02/04/2008
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