Provider Demographics
NPI:1417989567
Name:PETERSON, SIEGLINDE IRIS (MD)
Entity Type:Individual
Prefix:DR
First Name:SIEGLINDE
Middle Name:IRIS
Last Name:PETERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15111 TWELVE OAKS CENTER DR
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-5201
Mailing Address - Country:US
Mailing Address - Phone:952-993-4649
Mailing Address - Fax:952-993-4676
Practice Address - Street 1:15111 TWELVE OAKS CENTER DR
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-5201
Practice Address - Country:US
Practice Address - Phone:952-993-4649
Practice Address - Fax:952-993-4676
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN44814207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN132018OtherUCARE MN
MN2151648OtherAMERICA'S PPO
MN303M0PEOtherBCBS OF MN
MN6607782OtherMEDICA UC #
MNHP42876OtherHEALTHPARTNERS
MN697640900Medicaid
MN1041309OtherPREFERRED ONE
MN080013242Medicare ID - Type UnspecifiedWPS MEDICARE - B
MN697640900Medicaid