Healthcare Provider Details

I. General information

NPI: 1346339777
Provider Name (Legal Business Name): MICHAEL E PETERSON MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 02/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 N FOSTER
MITCHELL SD
57301-2902
US

IV. Provider business mailing address

1000 W 4TH ST STE 12
YANKTON SD
57078-3730
US

V. Phone/Fax

Practice location:
  • Phone: 605-668-8850
  • Fax: 605-668-9448
Mailing address:
  • Phone: 605-668-8704
  • Fax: 605-668-8605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MICHAEL E PETERSON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 605-668-8850