Petersen Medical Corp.

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

PETERSEN MEDICAL CORP.

Practice address

7235 Coral Way Ste 213
Miami, FL 33155-1452

Phone

(305) 846-9303

Fax

(305) 640-5705

NPI assigned

Jan 26, 2018

Organization subpart

No

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

Authorized official

Name

Kyle Petersen, DO

Title

President

Phone

(305) 846-9303

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1516924800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1516924800000",
    "number": "1891293668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7235 CORAL WAY STE 213",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331551452",
            "telephone_number": "305-846-9303",
            "fax_number": "305-640-5705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7235 CORAL WAY STE 213",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331551452",
            "telephone_number": "305-846-9303",
            "fax_number": "305-640-5705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETERSEN MEDICAL CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-26",
        "last_updated": "2018-01-26",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "KYLE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "305-846-9303",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adrienne K. Peters, M.ED.
• Ashley Peters, FNP
• Diane Peters, M.A.,CCC-SLP
• John M. Peters, D.O.
• Kenneth Michael Peters, M.A., SLP
• Melissa Petersen
• Paul Lewis Petersen, MD
• Amy Judith Peterson, B.S.W
• Catherine D Peterson, LCSW
• Christopher Scott Peterson, DPM

• Clinic/Center in Miami, FL
• Providers in Miami, FL by specialty
• Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2018; 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.