Petersen, Tara
Petersen, Tara is an individual health care provider with primary practice located at 9000 W Wisconsin Ave Ms 681, Milwaukee WI 53226-4874. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pediatrics, Allopathic & Osteopathic Physicians / Pediatric Critical Care Medicine. Allopathic & Osteopathic Physicians / Pediatric Critical Care Medicine is her primary health care specialty. Petersen, Tara can be contacted via phone (414) 266-3360.Contact Information
Primary practice address
9000 W Wisconsin Ave Ms 681
Milwaukee WI 53226-4874
Phone: (414) 266-3360
Fax: (414) 266-3563
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | MT189036 | Pennsylvania |
| Allopathic & Osteopathic Physicians / Pediatric Critical Care Medicine | 2080P0203X | 61162 | Wisconsin |
Profile Details
| NPI number | 1427255785 |
|---|---|
| LBN Legal business name | Petersen, Tara |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 29th, 2007 |
| Last updated | Dec 2nd, 2019 - about 5 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 | 1427255785 | NPPES |
| Wisconsin | MEDICAID | 1427255785 |
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