Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
MR. MARK FREDERIC PETERSON I
Active Sole ProprietorMR. MARK FREDERIC PETERSON I is a Emotionally Disturbed Children Residential Treatment healthcare provider located in GRAND RAPIDS, Michigan. NPI 1841474012 is currently active in the NPPES registry. Verify at CMS.
Emotionally Disturbed Children Residential Treatment · GRAND RAPIDS, MI
Registration Details
- NPI Number
- 1841474012
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Dec 24, 2007 (18.684547727518 yrs)
- Last Updated
- Dec 24, 2007
- License
-
6802071051 (MI)
- Sole Proprietor
- Yes
Practice Information
- Address
-
3351 36TH STGRAND RAPIDS, MI, 49331Browse MI providers · Browse ZIP 49331
- Phone
- 6168315659
- Primary Specialty
-
Emotionally Disturbed Children Residential Treatment
320900000X
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.