Active NPI
Phillip K Peterson, MD
- Infectious Disease Physician
- Minneapolis, MN
National Provider Identifier
1710928486
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Infectious Disease Physician
- License
- 22228
- Practice address
- 516 Delaware Street SE
Ump Delaware Street Clinic
Minneapolis, MN 55455 - Phone
- (612) 884-0649
- NPI assigned
- Jun 10, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Infectious Disease Physician | 207RI0200X | 22228 | MN | Primary |
Addresses
Primary practice location
516 Delaware Street SE
Ump Delaware Street Clinic
Minneapolis, MN 55455
Mailing address
720 Washington Ave SE
University of Minnesota Physicians
Minneapolis, MN 55414
Phone (612) 884-0649
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 112270300 | Medicaid | MN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22228 | MN | MD | Infectious Disease Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149897600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1351641600000",
"number": "1710928486",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "720 WASHINGTON AVE SE",
"address_2": "UNIVERSITY OF MINNESOTA PHYSICIANS",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "55414",
"telephone_number": "612-884-0649"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "516 DELAWARE STREET SE",
"address_2": "UMP DELAWARE STREET CLINIC",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "55455",
"telephone_number": "612-884-0649"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "PHILLIP",
"middle_name": "K",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-10",
"last_updated": "2012-10-31",
"status": "A"
},
"taxonomies": [
{
"code": "207RI0200X",
"taxonomy_group": "",
"desc": "Internal Medicine, Infectious Disease",
"state": "MN",
"license": "22228",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "112270300",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.