Provider Demographics
NPI:1669467817
Name:PETERSON, WILLIAM PAUL JR (MD)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:PAUL
Last Name:PETERSON
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:1200 E MICHIGAN AVE
Mailing Address - Street 2:STE 370
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-1800
Mailing Address - Country:US
Mailing Address - Phone:517-484-4451
Mailing Address - Fax:517-484-0291
Practice Address - Street 1:1200 E MICHIGAN AVE
Practice Address - Street 2:STE 370
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-1800
Practice Address - Country:US
Practice Address - Phone:517-484-4451
Practice Address - Fax:517-484-0291
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2007-12-19
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Provider Licenses
StateLicense IDTaxonomies
MI4301051190207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI103037120Medicaid
MI0C37630018Medicare PIN
E95427Medicare UPIN