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1912017104
KENNETH R. PETERSEN
GLENDALE, AZ
NPI
1912017104
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
207R00000X Internal Medicine
(Licence: IL 036-072554)
Enumeration Date
2006-08-30
Last Update Date
2023-06-14
Business Address
KENNETH R. PETERSEN MD
7701 W ASPERA BLVD
GLENDALE, AZ 85308-7947
Phone number: 623-465-6060
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Mailing Address
KENNETH R. PETERSEN MD
7702 N ALPINE RD
LOVES PARK, IL 61111-3107
Phone number: 815-971-2000
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