Tim Petersen
NPI 1689113680 · on the registry since 2017
Practice
- Address
- 32059 N State Route 97
Fairview, IL 61432 - Phone
- (309) 414-2155
Registry record
- Primary taxonomy
- Driver
172A00000X
- Licence states on file
- IL
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2017-02-23
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Illinois