MEDICARE: KIRSTEN D PETERSON MD

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
1	207R00000X	Internal Medicine Physician	37385	WI
2	207R00000X	Internal Medicine Physician	5959	ND

General Provider Information

NPI Number	:	1285636423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRSTEN D PETERSON MD

Provider Business Mailing Address
First Line	:	PO BOX 5074
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57117-5074
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	407 WASHINGTON AVE E
Second Line	:
City	:	FINLEY
State	:	ND
Zip	:	58230-3031
Country	:	US
Telephone Number	:	701-524-1005
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	04/29/2022

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Directions to “ KIRSTEN D PETERSON MD” Practice Location

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