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General NPI Number Information
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NPI Number | 1962532465
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Entity Type | Individual
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Provider Name | DAVID O. PETERSON D.O.
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Gender | Male
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 10/17/2016
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Provider Practice Location Address
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Address Line | 1840 WEALTHY ST SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49506-2921
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Country | US
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Telephone | 734-464-0887
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Fax | 734-402-0254
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Provider Business Mailing Address
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Address Line | 36123 SCHOOLCRAFT RD
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City | LIVONIA
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State | MI
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Zip | 48150-1216
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Country | US
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Telephone | 734-793-6140
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Fax | 734-402-0254
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 006401
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 5101006401
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License Number State | MI
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