Petersen, Jon Fredrick

Petersen, Jon Fredrick is an individual health care provider with primary practice located at 1750 E Lake Shore Dr , Decatur IL 62521-3803. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Occupational Medicine, Allopathic & Osteopathic Physicians / Family Medicine. Allopathic & Osteopathic Physicians / Occupational Medicine is his primary health care specialty. Petersen, Jon Fredrick can be contacted via phone (217) 464-1440.

Contact Information

Primary practice address
1750 E Lake Shore Dr Decatur IL 62521-3803
Phone: (217) 464-1440
Fax: (217) 464-1469
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Occupational Medicine 2083X0100X 036129728 Illinois
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 036129728 Illinois

Profile Details

NPI number 1285621516
LBN Legal business name Petersen, Jon Fredrick
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 3rd, 2005
Last updated Oct 12th, 2016 - about 8 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1285621516 NPPES
Other 250766 HEALTHLINK

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