Provider Demographics
NPI:1376707729
Name:PETERSON, CARRIE YVONNE (MD)
Entity Type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:YVONNE
Last Name:PETERSON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:COLORECTAL SURGERY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-5783
Mailing Address - Fax:414-454-0152
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:COLORECTAL SURGERY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-5783
Practice Address - Fax:414-454-0152
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2014-07-30
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Provider Licenses
StateLicense IDTaxonomies
CAA99907208600000X
WI62650208C00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery