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General NPI Number Information
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NPI Number | 1053500413
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Entity Type | Organization
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Legal Business Name | CAROL E. PETERSON, MD PLC
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Dates
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Enumeration Date | 10/22/2007
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Last Update Date | 02/14/2008
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Provider Practice Location Address
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Address Line | 6050 N US HIGHWAY 31
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City | FREE SOIL
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State | MI
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Zip | 49411-9157
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Country | US
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Telephone | 231-757-1260
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Fax | 231-757-1261
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Provider Business Mailing Address
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Address Line | 6050 N US HIGHWAY 31
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City | FREE SOIL
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State | MI
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Zip | 49411-9157
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Country | US
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Telephone | 231-757-1260
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Fax | 231-757-1261
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Authorized Official
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Title or Position | PATIENT ACCOUNTS MANAGER
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Name | MRS. HEATHER RYAN BOEREMA
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Credential | CPC
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Telephone | 231-757-1260
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 4301050870
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License Number State | MI
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