Individual
MICHAEL ROBERT PATRICK PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10010 KENNERLY RD, SAINT LOUIS, MO 63128-2106
(314) 525-1328
Mailing address
10010 KENNERLY RD, SAINT LOUIS, MO 63128-2106
(314) 525-1328
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
2023032883
MO
Other
Enumeration date
03/20/2019
Last updated
08/14/2024
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