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NPI Code Detail

MEDICARE: DR. MARY ELIZABETH PETERSON AU.D.

MEDICARE: DR. MARY ELIZABETH PETERSON AU.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
1231H00000XAudiologist

General Provider Information

NPI Number : 1164406955
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARY ELIZABETH PETERSON AU.D.
Provider Business Mailing Address
First Line : 1000 OAKLAND DR FL 3
Second Line : WMU UNIFIED CLINICS CHARLES VAN RIPER LANGUAGE SPEECH
City : KALAMAZOO
State : MI
Zip : 49008-1282
Country : US
Telephone Number : 269-387-7209
Fax Number : 269-387-7227
Provider Business Practice Location Address
First Line : 1000 OAKLAND DR FL 3
Second Line : WMU UNIFIED CLINICS CHARLES VAN RIPER LANGUAGE SPEECH
City : KALAMAZOO
State : MI
Zip : 49008-1282
Country : US
Telephone Number : 269-387-7209
Fax Number : 269-387-7227
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/05/2005
Last Update Date : 08/28/2013

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