Petersen, Michael T
Petersen, Michael T is an individual health care provider with primary practice located at 25 Main Pl Suite 425, Council Bluffs IA 51503-0792. He recently has only one registered license in Allopathic & Osteopathic Physicians / Anesthesiology, which is considered as his primary health care specialty. Petersen, Michael T can be contacted via phone (712) 322-5565.Contact Information
Primary practice address
25 Main Pl Suite 425
Council Bluffs IA 51503-0792
Phone: (712) 322-5565
Fax: (712) 322-5566
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Anesthesiology | 207L00000X | 28268 | Iowa |
Profile Details
| NPI number | 1609849736 |
|---|---|
| LBN Legal business name | Petersen, Michael T |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Feb 9th, 2006 |
| Last updated | Nov 6th, 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1609849736 | NPPES |
| Iowa | MEDICAID | 075051 |
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