Carol E. Peterson, MD PLC

Primary specialty

Hematology & Oncology PhysicianTaxonomy code 207RH0003X

License

4301050870 Issued in MI

Legal business name

CAROL E. PETERSON, MD PLC

Practice address

6050 N US Highway 31
Free Soil, MI 49411-9157

Phone

(231) 757-1260

Fax

(231) 757-1261

NPI assigned

Oct 22, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Heather Ryan Boerema, CPC

Title

Patient Accounts Manager

Phone

(231) 757-1260

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1193011200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202947200000",
    "number": "1053500413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6050 N US HIGHWAY 31",
            "city": "FREE SOIL",
            "state": "MI",
            "postal_code": "494119157",
            "telephone_number": "231-757-1260",
            "fax_number": "231-757-1261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6050 N US HIGHWAY 31",
            "city": "FREE SOIL",
            "state": "MI",
            "postal_code": "494119157",
            "telephone_number": "231-757-1260",
            "fax_number": "231-757-1261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROL E. PETERSON, MD PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-22",
        "last_updated": "2008-02-14",
        "status": "A",
        "authorized_official_last_name": "BOEREMA",
        "authorized_official_first_name": "HEATHER",
        "authorized_official_middle_name": "RYAN",
        "authorized_official_title_or_position": "PATIENT ACCOUNTS MANAGER",
        "authorized_official_telephone_number": "231-757-1260",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CPC"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "MI",
            "license": "4301050870",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUS SHIELD",
            "identifier": "0531035",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4831985",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shelby Fricke
• Katelyn Graczyk
• Susan K Henry, MD
• Richard Lee Mogerman, MD
• Amanda Nasor

• Hematology & Oncology Physician in Free Soil, MI
• Providers in Free Soil, MI by specialty
• Hematology & Oncology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.