DR. MICHAEL R PETERSEN (NPI# 1629005160) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629005160 |
| Entity Type | Individual |
| Full Name | DR. MICHAEL R PETERSEN |
| Credential | MD |
| Practice Address |
2000 N Huron River Dr Ste 100 Ypsilanti MI 48197 |
| Mailing Address |
39650 Orchard Hill Pl Ste 200 Novi MI 48375-5391 |
| Practice Telephone | 7345721200 |
| Practice Fax Number | 7345729760 |
| Mailing Telephone | 2483190161 |
| Mailing Fax Number | 2483190170 |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2020-08-04 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207W00000X | Ophthalmology | 35-06-3107 | OH | Allopathic & Osteopathic Physicians |
| Y | 207WX0107X |
Ophthalmology Specialization: Retina Specialist |
4301406847 | MI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| BCBS | 000000021228 | 01 | |
| OH | 0886528 | 05 | |
| KY | 64930167 | 05 | |
| IN | 100374400 | 05 | |
| OH | RAIL ROAD MEDICARE | 180026057 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740602960 | Michael Petersen | Veterinarian | 5754 Nicollet Ave, Minneapolis, MN 55419-2415 | 2014-01-07 |
| 1407902307 | Michael James Petersen | Dentist | 3101 Old Highway 8, Suite #303, Roseville, MN 55113-1072 | 2007-01-25 |
| 1881798379 | Michael Charles Petersen | Pediatrics | 12356 Riata Trace Pkwy # 6006-b, Austin, TX 78727-6417 | 2006-09-12 |
| 1467428656 | Michael S Petersen | Orthopaedic Surgery | 2020 Sutter Pl, Suite 104, Davis, CA 95616-6213 | 2006-02-27 |
| 1609849736 | Michael T Petersen | Anesthesiology | 25 Main Pl, Suite 425, Council Bluffs, IA 51503-0792 | 2006-02-09 |
| 1639785579 | Michael Lee Petersen | Pharmacist | 900 W Clairemont Ave, Eau Claire, WI 54701-6122 | 2020-09-16 |
| 1780248146 | Michael Jake Petersen | Student in an Organized Health Care Education/Training Program | 600 S Paulina St Ste 403, Chicago, IL 60612-3806 | 2019-04-30 |
| 1093182552 | Michael Petersen | Counselor | 1067 E Tabernacle St, Suite 7, Saint George, UT 84770-3163 | 2015-08-31 |
| 1972746931 | Michael G Petersen | Physician Assistant | 7201 Manchaca Rd, Ste B, Austin, TX 78745-5283 | 2009-04-07 |
| 1518974153 | Michael J Petersen | Podiatrist | 3922 Mercy Dr, Mchenry, IL 60050-3151 | 2006-08-02 |
| Street Address |
2000 N HURON RIVER DR STE 100 |
| City | YPSILANTI |
| State | MI |
| Zip Code | 48197 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700423092 | Devika Dibya Choudhuri | Counselor | 135 Porter West Circle Drive, Ypsilanti, MI 48197 | 2019-12-05 |
| 1770128837 | Brian Lee Shue | Registered Nurse | 6277 Maplehurst Dr, Ypsilanti, MI 48197 | 2019-11-13 |
| 1639721566 | Darlene E Bellers | 845 W. Circle Dr, Suite 160, Ypsilanti, MI 48197 | 2019-07-11 | |
| 1073165874 | Eastern Michigan University | Dietitian, Registered | Suite 160 Rackham, Ypsilanti, MI 48197 | 2019-07-11 |
| 1447815469 | Rainbow Rehabilitation Centers, Inc. | Community Based Residential Treatment Facility, Mental Illness | 6200 Textile Rd, Ypsilanti, MI 48197 | 2019-05-06 |
| 1417416298 | Justin Brewer | Student in an Organized Health Care Education/Training Program | 5333 Mcauley Drive Suite 2115, Ypsilanti, MI 48197 | 2019-03-19 |
| 1124519780 | Great Lakes Mindfulness LLC | Community/Behavioral Health | 4007 Carpenter Rd # 280, Ypsilanti, MI 48197 | 2018-05-19 |
| 1841799715 | Bedside Angel's Home Care, LLC | Home Health | 2032 S. Congress Street, Ypsilanti, MI 48197 | 2018-02-06 |
| 1891211777 | Brandon James Kukal | Specialist/Technologist | 799 N Hewitt, Ypslinati, MI 48197 | 2017-08-22 |
| 1669908737 | Michael Bekkerman | Student in an Organized Health Care Education/Training Program | 5303 Elliot Drive, Cancer Center, Ypsilanti, MI 48197 | 2017-05-10 |
| Find all providers in zip 48197 | ||||
| Taxonomy Code | 207WX0107X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Ophthalmology |
| Specialization | Retina Specialist |
| An ophthalmologist who specializes in the diagnosis and treatment of vitreoretinal diseases. |
| Notes: Source: American Society of Retina Specialists, www.asrs.org [1/1/2017: new] - Additional Resources: American Academy of Ophthalmology, www.aao.org. Macula Society, www.maculasociety.org. Retina Society, www.retinasociety.org. Association of University Professors of Ophthalmology, www.aupo.org. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639781545 | Harbor Retina Center Pllc | Ophthalmology | 3273 Davison Rd Ste 1, Lapeer, MI 48446-2902 | 2020-08-21 |
| 1902260698 | Drew Scoles | Ophthalmology | 3555 W 13 Mile Rd Ste Ll-20, Royal Oak, MI 48073-6710 | 2016-04-08 |
| 1225007198 | Steven A Boskovich Md PC | Ophthalmology | 1290 S Linden Rd, Flint, MI 48532-3407 | 2006-03-14 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.