David S. Petersen, M.D.S.C.

LBN: David S. Petersen, M.D.S.C.
David S. Petersen, M.D.S.C. is an health care organization with primary practice located at 2121 1St Street A , Moline IL 61265-7745. The organization recently has only one registered license in Allopathic & Osteopathic Physicians / Urology, which is considered as the primary health care specialty. David S. Petersen, M.D.S.C. can be contacted via phone (309) 764-9790, or through Petersen, David S via phone (309) 764-9790.

Contact Information

Primary practice address
2121 1St Street A Moline IL 61265-7745
Phone: (309) 764-9790
Fax: (309) 764-9632
Website:
Map and Directions
Authorized official contact:
Name: Petersen, David S Doctor of Medicine (MD)
Phone: (309) 764-9790

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Urology 208800000X 036-055984 Illinois

Profile Details

NPI number 1982900825
LBN Legal business name David S. Petersen, M.D.S.C.
DBA Doing business as
Authorized official Petersen, David S Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date Feb 9th, 2011
Last updated Feb 9th, 2011 - about 14 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1982900825 NPPES
Illinois MEDICAID 036055984

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