Peterson, Antonique

Peterson, Antonique is an individual health care provider with primary practice located at 1313 Penn Ave N , Minneapolis MN 55411-3047. She recently has 2 registered licenses in different health care specialties including Student, Health Care / Student in an Organized Health Care Education/Training Program, Allopathic & Osteopathic Physicians / General Practice. Allopathic & Osteopathic Physicians / General Practice is her primary health care specialty. Peterson, Antonique can be contacted via phone (612) 543-2500.

Contact Information

Primary practice address
1313 Penn Ave N Minneapolis MN 55411-3047
Phone: (612) 543-2500
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Student, Health Care / Student in an Organized Health Care Education/Training Program 390200000X
Allopathic & Osteopathic Physicians / General Practice 208D00000X 69440 Minnesota

Profile Details

NPI number 1700377124
LBN Legal business name Peterson, Antonique
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date May 21st, 2018
Last updated Oct 27th, 2021 - 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1700377124 NPPES
Minnesota MEDICAID 416005801

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