Individual
DR. THEODORE VINCENT PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, PHD
Contact information
Practice address
420 DELAWARE STREET SE, MMC 292, MINNEAPOLIS, MN 55455
(612) 625-6916
Mailing address
420 DELAWARE STREET SE, MMC 292, MINNEAPOLIS, MN 55455
(612) 625-6916
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/19/2022
Last updated
06/08/2023
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