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General NPI Number Information
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NPI Number | 1033219399
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Entity Type | Individual
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Provider Name | DANITA LUCETTE PEOPLES-PETERSON MD
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Gender | Female
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5103 EASTMAN AVE SUITE 255
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City | MIDLAND
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State | MI
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Zip | 48640
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Country | US
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Telephone | 989-832-7915
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Fax | 989-832-7915
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Provider Business Mailing Address
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Address Line | 5103 EASTMAN AVE SUITE 255
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City | MIDLAND
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State | MI
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Zip | 48640
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Country | US
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Telephone | 989-832-7915
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Fax | 989-832-0080
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 4301046057
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License Number State | MI
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