Petersen, Michael R
Petersen, Michael R is an individual health care provider with primary practice located at 2000 N Huron River Dr Ste 100 , Ypsilanti MI 48197. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Ophthalmology, Allopathic & Osteopathic Physicians / Retina Specialist. Allopathic & Osteopathic Physicians / Retina Specialist is his primary health care specialty. Petersen, Michael R can be contacted via phone (734) 572-1200.Contact Information
Primary practice address
2000 N Huron River Dr Ste 100
Ypsilanti MI 48197
Phone: (734) 572-1200
Fax: (734) 572-9760
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Ophthalmology | 207W00000X | 35-06-3107 | Ohio |
| Allopathic & Osteopathic Physicians / Retina Specialist | 207WX0107X | 4301406847 | Michigan |
Profile Details
| NPI number | 1629005160 |
|---|---|
| LBN Legal business name | Petersen, Michael R |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 28th, 2006 |
| Last updated | Aug 4th, 2020 - about 4 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 | 1629005160 | NPPES |
| Ohio | Other | 180026057 | RAIL ROAD MEDICARE |
| Ohio | MEDICAID | 100374400 | RAIL ROAD MEDICARE |
| Ohio | Other | 000000021228 | RAIL ROAD MEDICARE |
| Ohio | MEDICAID | 0886528 | RAIL ROAD MEDICARE |
| Ohio | MEDICAID | 64930167 | RAIL ROAD MEDICARE |
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