| Organization Name: | JEFFREY R PETERMAN MD PC |
| NPI Number: | 1316298326 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JEFFREY R PETERMAN (MEDICAL DOCTOR) |
| Mailing Address: | 333 Magazine St Suite 102 Sault Sainte Marie |
| State: | MI US |
| Postal Code: | 497831867 |
| Phone Number: | 9062539374 |
| Fax Number: | 9062539002 |
| NPI Enumeration Date: | 10/01/2012 |
| NPI Last Update Date: | 10/01/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 385H00000X |
| License Number: | 4301073421 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Respite Care Facility |
| Taxonomy Classification: | Respite Care |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |