MARIO CESAR PETERSEN (NPI# 1760490239) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760490239 |
| Entity Type | Individual |
| Full Name | MARIO CESAR PETERSEN |
| Credential | MD |
| Practice Address |
35 Michigan St Ne Ste 3003 Grand Rapids MI 49503-2528 |
| Mailing Address |
100 Michigan St Ne # Mc845 Grand Rapids MI 49503-2560 |
| Practice Telephone | 6162672009 |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2019-05-31 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2080P0006X |
Pediatrics Specialization: Developmental – Behavioral Pediatrics |
4301116723 | MI | Allopathic & Osteopathic Physicians |
| Y | 2080P0008X |
Pediatrics Specialization: Neurodevelopmental Disabilities |
4301116723 | MI | Allopathic & Osteopathic Physicians |
| Street Address |
35 MICHIGAN ST NE STE 3003 |
| City | GRAND RAPIDS |
| State | MI |
| Zip Code | 49503-2528 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215921432 | Brian Eric Woodruff | Psychiatry & Neurology | 35 Michigan St Ne Ste 3003, Grand Rapids, MI 49503-2528 | 2005-09-02 |
| 1184232332 | Erin Elizabeth Swartz | Physical Therapist | 35 Michigan St Ne Ste 3003, Grand Rapids, MI 49503-2528 | 2020-07-14 |
| 1407471220 | Katelyn Biros | Dietitian, Registered | 35 Michigan St Ne Ste 3003, Grand Rapids, MI 49503-2528 | 2020-06-09 |
| 1225668973 | Katelyn Frances Eling | Speech-Language Pathologist | 35 Michigan St Ne Ste 3003, Grand Rapids, MI 49503-2528 | 2020-01-22 |
| 1285264929 | Heather Lynette Francis | Speech-Language Pathologist | 35 Michigan St Ne Ste 3003, Grand Rapids, MI 49503-2528 | 2020-01-22 |
| 1225671381 | Dana Elise Reckley | Nurse Practitioner | 35 Michigan St Ne Ste 3003, Grand Rapids, MI 49503-2528 | 2019-10-22 |
| 1952950347 | Breanna Marie Beltz | Physician Assistant | 35 Michigan St Ne Ste 3003, Grand Rapids, MI 49503-2528 | 2019-09-09 |
| 1902374267 | Gregory Scott Balloid | Nurse Practitioner | 35 Michigan St Ne Ste 3003, Grand Rapids, MI 49503-2528 | 2018-11-05 |
| 1972086379 | Zoey M Rose | Occupational Therapist | 35 Michigan St Ne Ste 3003, Grand Rapids, MI 49503-2528 | 2018-09-11 |
| 1720584931 | Gretchen Berry | Social Worker | 35 Michigan St Ne Ste 3003, Grand Rapids, MI 49503-2528 | 2018-04-05 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801496195 | Airway Oxygen, Inc. | Durable Medical Equipment & Medical Supplies | Lemmen Holton Cancer Pavilion, 145 Michigan St Ne Ste 3400, Grand Rapids, MI 49503 | 2020-10-27 |
| 1730707282 | Adriana Molina-schmuker | Counselor | 901 Eastern Avenue Ne, Grand Rapids, MI 49503 | 2020-07-10 |
| 1477176949 | Kimberly Buskirk | Specialist | 1131 Ionia Ava Nw, Grand Rapids, MI 49503 | 2020-05-19 |
| 1124647805 | Jared Host | Speech-Language Pathologist | Mercy Health Hauenstein Neuroscience Center 220 Cherry, Grand Rapids, MI 49503 | 2020-04-13 |
| 1265061378 | Heather Gladfelter | Student in an Organized Health Care Education/Training Program | 339 Barclay Ave Ne Ste 300, Grand Rapids, MI 49503 | 2020-04-02 |
| 1194368647 | Amy Jo Arends | Nurse Practitioner | 350 Lafayette S.e., Suite 301, Grand Rapids, MI 49503 | 2019-10-28 |
| 1376185199 | Beth Arce | Occupational Therapist | 245 Cherry St Se Suite 302, Grand Rapids, MI 49503 | 2019-10-14 |
| 1295387256 | Althea Ziolkowski | Licensed Practical Nurse | Salvation Army Turning Point Programs, 1215 Fulton St E, Grand Rapids, MI 49503 | 2019-07-10 |
| 1790340719 | Heather Anne Fox | Occupational Therapist | Marywood, 111 Lakeside Dr Ne, Grand Rapids, MI 49503 | 2019-05-06 |
| 1184182883 | April L Kaiserlian | Social Worker | 983 Spaulding Ave Ne, Ada, MI 49503 | 2019-03-12 |
| Find all providers in zip 49503 | ||||
| Taxonomy Code | 2080P0008X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Neurodevelopmental Disabilities |
| A pediatrician who treats children having developmental delays or learning disorders including those associated with visual and hearing impairment, mental retardation, cerebral palsy, spina bifida, autism and other chronic neurologic conditions. This specialist provides medical consultation and education and assumes leadership in the interdisciplinary management of children with neurodevelopmental disorders. They may also focus on the early identification and diagnosis of neurodevelopmental disabilities in infants and young children as well as on changes that occur as the child with developmental disabilities grows. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition changed, source changed] Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922582196 | Spectrum Health Primary Care Partners | Pediatrics | 360 Lafayette Ave Se Ste 400, Grand Rapids, MI 49503-4677 | 2018-09-24 |
| 1578860912 | Spectrum Health Primary Care Partners | Pediatrics | 700 Fuller Ave Ne, Grand Rapids, MI 49503-1918 | 2011-02-22 |
| 1538205539 | Vivek Baluja | Pediatrics | 35 Michigan St Ne, Suite 3003, Grand Rapids, MI 49503-2514 | 2007-01-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982904587 | Spectrum Health Primary Care Partners | Pediatrics | 550 W Grand Ave, Muskegon, MI 49441-2336 | 2010-10-28 |
| 1730354994 | Kheir Al Zouhayli Md PC | Pediatrics | 1639 E Big Beaver, 104, Troy, MI 48083 | 2008-04-28 |
| 1528048501 | Yasser Awaad | Pediatrics | 1331 Monroe St, Dearborn, MI 48124-2888 | 2006-01-18 |
| 1669779005 | Spectrum Health Primary Care Partners | Pediatrics | 100 Pine St, Suite 225, Zeeland, MI 49464-2600 | 2011-02-22 |
| 1710104187 | Genesys Regional Medical Center | Pediatrics | 4642 Genesys Pkwy, Grand Blanc, MI 48439-8067 | 2007-04-19 |
| 1962543660 | Colleen Noble | Pediatrics | 461 W Huron St, Nomc Developmental Pediatrics, Pontiac, MI 48341-1601 | 2007-02-08 |
| 1164571824 | Oakwood Young Programs, LLC | Pediatrics | 25650 Outer Dr, Lincoln Park, MI 48146-2096 | 2007-01-10 |
| 1740375914 | Douglas G Postels | Pediatrics | 804 Service Rd, A217, East Lansing, MI 48824-7015 | 2006-10-04 |
| City | GRAND RAPIDS |
| Zip Code | 49503 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.