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NPI Code Detail

MEDICARE: DR. MATTHEW CHRISTIAN PETERSON DPM

MEDICARE: DR. MATTHEW CHRISTIAN PETERSON DPM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1213ES0103XFoot & Ankle Surgery Podiatrist871MN

General Provider Information

NPI Number : 1083840664
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MATTHEW CHRISTIAN PETERSON DPM
Provider Business Mailing Address
First Line : 6545 FRANCE AVE S STE 150
Second Line :
City : EDINA
State : MN
Zip : 55435-2180
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6545 FRANCE AVE S STE 150
Second Line :
City : EDINA
State : MN
Zip : 55435-2180
Country : US
Telephone Number : 952-848-5600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2009
Last Update Date : 09/29/2015

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Directions to “ DR. MATTHEW CHRISTIAN PETERSON DPM” Practice Location

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