| Doctor Name: | DR. KETTI SOPHIA PETERSEN |
| NPI Number: | 1003128919 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MD |
| License Number: | 4301096617 |
| Business Practice Address: | 14700 East Old Us 12 Chelsea, MI - 481181185 |
| Business Phone Number: | 7344751321 |
| Business Fax Number: | |
| Mailing Address: | 3621 South State Street, 700 Kms Place ANN ARBOR |
| State: | MI |
| Postal Code: | 48108 |
| Phone Number: | 7349362047 |
| Fax Number: | |
| NPI Enumeration Date: | 07/08/2010 |
| NPI Last Update Date: | 03/31/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 390200000X |
| License Number: | 4301096617 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MI |
| Taxonomy Type: | Student, Health Care |
| Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |