Provider Demographics
NPI:1154641280
Name:PETERSEN, LINDSAY F (MD)
Entity Type:Individual
Prefix:DR
First Name:LINDSAY
Middle Name:F
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2799 WEST GRAND BOULEVARD
Mailing Address - Street 2:CFP 369
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202
Mailing Address - Country:US
Mailing Address - Phone:313-399-4967
Mailing Address - Fax:313-916-9556
Practice Address - Street 1:2799 WEST GRAND BOULEVARD
Practice Address - Street 2:CFP 369
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202
Practice Address - Country:US
Practice Address - Phone:313-399-4967
Practice Address - Fax:313-916-9556
Is Sole Proprietor?:No
Enumeration Date:2010-06-11
Last Update Date:2021-02-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301106616208600000X, 2086X0206X
IL125-058452208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery