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NPI Code Detail

MEDICARE: DR. JESSICA ARETHA PETERSON M.D.

MEDICARE: DR. JESSICA ARETHA 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
1207V00000XObstetrics & Gynecology Physician036163367IL
2390200000XStudent in an Organized Health Care Education/Training Program
3207VM0101XMaternal & Fetal Medicine Physician036163367IL

General Provider Information

NPI Number : 1013361666
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JESSICA ARETHA PETERSON M.D.
Provider Business Mailing Address
First Line : 1136 S DELANO CT W
Second Line :
City : CHICAGO
State : IL
Zip : 60605-3740
Country : US
Telephone Number : 813-610-5996
Fax Number :
Provider Business Practice Location Address
First Line : 6250 S COTTAGE GROVE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60637-2530
Country : US
Telephone Number : 773-702-2193
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2016
Last Update Date : 05/23/2024

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