Peterson, Phillip K

Peterson, Phillip K is an individual health care provider with primary practice located at 516 Delaware Street Se Ump Delaware Street Clinic, Minneapolis MN 55455. He recently has only one registered license in Allopathic & Osteopathic Physicians / Infectious Disease, which is considered as his primary health care specialty. Peterson, Phillip K can be contacted via phone (612) 884-0649.

Contact Information

Primary practice address
516 Delaware Street Se Ump Delaware Street Clinic Minneapolis MN 55455
Phone: (612) 884-0649
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Infectious Disease 207RI0200X 22228 Minnesota

Profile Details

NPI number 1710928486
LBN Legal business name Peterson, Phillip K
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 10th, 2006
Last updated Oct 31st, 2012 - about 12 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 1710928486 NPPES
Minnesota MEDICAID 112270300

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