Peterson, Keith Hershel

Peterson, Keith Hershel is an sole proprietor health care provider with primary practice located at 400 E 3Rd St Essentia Health Duluth Clinic, Duluth MN 55805-1951. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Pediatrics. Allopathic & Osteopathic Physicians / Internal Medicine is his primary health care specialty. Peterson, Keith Hershel can be contacted via phone (218) 786-4020.

Contact Information

Primary practice address
400 E 3Rd St Essentia Health Duluth Clinic Duluth MN 55805-1951
Phone: (218) 786-4020
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 49588 Minnesota
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 49588 Minnesota
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 62724-20 Wisconsin

Profile Details

NPI number 1689718637
LBN Legal business name Peterson, Keith Hershel
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Feb 15th, 2007
Last updated Dec 2nd, 2015 - about 10 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 1689718637 NPPES
Minnesota MEDICAID 1689718637

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