MEDICARE: DR. JILL M BOWMAN PETERSON M.D.

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
1	207R00000X	Internal Medicine Physician	56818	MN

General Provider Information

NPI Number	:	1770876682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JILL M BOWMAN PETERSON M.D.

Provider Business Mailing Address
First Line	:	7244 YORK AVE S APT 317
Second Line	:
City	:	EDINA
State	:	MN
Zip	:	55435-4491
Country	:	US
Telephone Number	:	641-860-0191
Fax Number	:

Provider Business Practice Location Address
First Line	:	420 DELAWARE ST SE, MMC741
Second Line	:	UNIVERSITY OF MINNESOTA MEDICAL CENTER
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55455-0356
Country	:	US
Telephone Number	:	612-624-8984
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2011
Last Update Date	:	01/08/2016

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