Petersen, David P
Petersen, David P is an individual health care provider with primary practice located at 1111 Leffingwell Ave Ne Suite 200, Grand Rapids MI 49525-6406. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Surgery, Allopathic & Osteopathic Physicians / Surgery of the Hand. Allopathic & Osteopathic Physicians / Surgery of the Hand is his primary health care specialty. Petersen, David P can be contacted via phone (616) 957-4263.Contact Information
Primary practice address
1111 Leffingwell Ave Ne Suite 200
Grand Rapids MI 49525-6406
Phone: (616) 957-4263
Fax: (616) 957-0444
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | 4301039798 | Michigan |
| Allopathic & Osteopathic Physicians / Surgery of the Hand | 2086S0105X | 4301039798 | Michigan |
Profile Details
| NPI number | 1558353540 |
|---|---|
| LBN Legal business name | Petersen, David P |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 17th, 2005 |
| Last updated | Apr 24th, 2008 - about 16 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1558353540 | NPPES |
| Michigan | MEDICAID | 4096458 |
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