DR. MD Michael R Petersen, NPI 1629005160
Retina Specialist (Ophthalmology) Physician in Ypsilanti, MI, US

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NPI number: what is it?

The NPI, or National Provider Identifier, is a non-repeatable number for health care providers. The NPI always consists of 10 digits and is used for administrative and financial procedures. The NPI wa...

NPI 1629005160
NPI Entity Type Individual
Provider Name DR. MD Michael R Petersen
Enumeration Date September 30, 2009
Last Update Date September 30, 2009
Certification Date September 30, 2009
Provider Location Address 2000 N Huron River Dr Ste 100, Ypsilanti, MI, US
Provider Mailing Address 39650 Orchard Hill Pl Ste 200, Novi, MI, US, 483755391
Gender Male
Is Sole Proprietor? No
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Primary Taxonomy

Taxonomy Code

207WX0107X

Taxonomy Name Retina Specialist (Ophthalmology) Physician
Classification

Ophthalmology

Group

Allopathic & Osteopathic Physicians

License No. 4301406847
License State MI
Description An ophthalmologist who specializes in the diagnosis and treatment of vitreoretinal diseases.

Business Address

DR. MD Michael R Petersen
2000 N Huron River Dr Ste 100

Ypsilanti, MI, US

Phone: 734-572-1200
Fax: 734-572-9760

Mailing Address

DR. MD Michael R Petersen
39650 Orchard Hill Pl Ste 200
Novi, MI, US
ZIP 483755391
Phone: 248-319-0161
Fax: 248-319-0170

Secondary Taxonomies

Taxonomy Code Group Classification License No. State Primary?

207W00000X

Allopathic & Osteopathic Physicians

Ophthalmology

35-06-3107 OH No

Other Identifiers

Identifier Identifier State Identifier Issuer Type/Code
180026057 OH RAIL ROAD MEDICARE 01
100374400 IN MEDICAID 05
000000021228 BCBS 01
0886528 OH MEDICAID 05
64930167 KY MEDICAID 05

Health Information Exchange

Endpoint Type Endpoint Description Use Content Type Affiliation Location
DIRECT [email protected] No 2000 N Huron River Dr Ste 100, Ypsilanti, MI, US

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