KELLY M PETERSON — Medicare Enrolled Provider (PRACTITIONER - PHYSICIAN ASSISTANT, MI)
KELLY M PETERSON — Medicare Enrolled Provider (PRACTITIONER - PHYSICIAN ASSISTANT, MI) is one of 9,000 enrolled providers in the MedicareEnroll dataset. Key details — Name: KELLY M PETERSON; Type: Individual; NPI: 1003217860.
| Name | KELLY M PETERSON |
|---|---|
| Type | Individual |
| NPI | 1003217860 |
| Provider type | PRACTITIONER - PHYSICIAN ASSISTANT |
| State | MI |
| Enrollment ID | I20150401001821 |
| Multiple NPI flag | N |
| Source | CMS Medicare FFS Public Provider Enrollment (PECOS) |
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