Petersen, Michael J

Petersen, Michael J is an individual health care provider with primary practice located at 3922 Mercy Dr , Mchenry IL 60050-3151. He recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Podiatrist, which is considered as his primary health care specialty. Petersen, Michael J can be contacted via phone (815) 344-4499.

Contact Information

Primary practice address
3922 Mercy Dr Mchenry IL 60050-3151
Phone: (815) 344-4499
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Podiatrist 213E00000X Illinois

Profile Details

NPI number 1518974153
LBN Legal business name Petersen, Michael J
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 2nd, 2006
Last updated Jul 8th, 2007 - about 17 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.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1518974153 NPPES
Illinois MEDICAID 016002938 1

Popular Providers