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NPI Code Detail

MEDICARE: ADAM PETERSON M.D.

MEDICARE: ADAM 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
12084P0804XChild & Adolescent Psychiatry Physician11710SD

General Provider Information

NPI Number : 1033539937
Entity Type Code : Individual
Provider Name (Legal Business Name) : ADAM PETERSON M.D.
Provider Business Mailing Address
First Line : 1900 E BRIAR DEN CT
Second Line :
City : SIOUX FALLS
State : SD
Zip : 57108-5112
Country : US
Telephone Number : 605-940-1450
Fax Number :
Provider Business Practice Location Address
First Line : 4500 N LEWIS AVE
Second Line :
City : SIOUX FALLS
State : SD
Zip : 57104-7111
Country : US
Telephone Number : 605-322-6368
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/18/2014
Last Update Date : 11/07/2019

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