Petersen, Jerald Miles
Petersen, Jerald Miles is an individual health care provider with primary practice located at 1275 Lindokken Rd Ste 315 , Mount Horeb WI 53572-9701. He recently has only one registered license in Allopathic & Osteopathic Physicians / Hospitalist, which is considered as his primary health care specialty. Petersen, Jerald Miles can be contacted via phone (000) 000-0000.Contact Information
Primary practice address
1275 Lindokken Rd Ste 315
Mount Horeb WI 53572-9701
Phone: (000) 000-0000
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Hospitalist | 208M00000X | 64866 | Wisconsin |
Profile Details
| NPI number | 1649209032 |
|---|---|
| LBN Legal business name | Petersen, Jerald Miles |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 30th, 2006 |
| Last updated | Feb 13th, 2022 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1649209032 | NPPES |
| Minnesota | MEDICAID | 732880000 |
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