IndividualActive
Michael Petersen, MD
NPI 1780248146 · Pediatric Sports Medicine Physician · Seattle, WA
Provider details
- NPI number
- 1780248146
- Entity type
- Individual
- Primary specialty
- Pediatric Sports Medicine PhysicianAllopathic & Osteopathic Physicians
- Credential
- MD
- Sex
- Male
- Sole proprietor
- Yes
- License
- MD.MD.61679347 (WA)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
3800 Montlake Blvd
Seattle, WA 98195-0007
Phone: (206) 520-5000
Approximate (ZIP-level) locationGet directions
Mailing address
2516 Stockton Blvd
Sacramento, CA 95817-2208
Registry dates
- Enumerated
- 2019-04-30
- Last updated
- 2026-04-11
- Certified
- 2026-04-11
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.