Provider Demographics
NPI:1134481831
Name:PETERSON, JOHANNA SUZANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHANNA
Middle Name:SUZANNE
Last Name:PETERSON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3901 RAINBOW BLVD. 4070 DELP, MS 4017
Mailing Address - Street 2:KANSSAS UNIVERSITY PHYSICIANS, INC.
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160-0001
Mailing Address - Country:US
Mailing Address - Phone:913-588-2501
Mailing Address - Fax:913-588-0593
Practice Address - Street 1:3901 RAINBOW BLVD. 6040 DELP, MS1020
Practice Address - Street 2:DIVISION OF GENERAL AND GERIATRIC MEDICINE, UNIVERSITY
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-0001
Practice Address - Country:US
Practice Address - Phone:913-588-6005
Practice Address - Fax:913-588-3877
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-09
Last Update Date:2022-07-21
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Provider Licenses
StateLicense IDTaxonomies
KS9407884207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology