Individual
DR. MATTHEW JAMES PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1701 N SENATE BLVD, RADIOLOGY DEPT, INDIANAPOLIS, IN 46202-1239
(317) 962-5740
Mailing address
714 N SENATE AVE, STE 100, INDIANAPOLIS, IN 46202-3763
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
01069464A
IN
2085R0202X
Diagnostic Radiology Physician
11013619A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201027110
—
IN
01
—
P00966874
RAILROAD MEDICARE
IN
Enumeration date
07/14/2008
Last updated
10/28/2011
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