Provider Demographics
NPI:1912971615
Name:PETERSON, KARL A (MD)
Entity type:Individual
Prefix:DR
First Name:KARL
Middle Name:A
Last Name:PETERSON
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10101 ORCAS AVE
Mailing Address - Street 2:
Mailing Address - City:SUNLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91040-1380
Mailing Address - Country:US
Mailing Address - Phone:818-381-2573
Mailing Address - Fax:818-949-4981
Practice Address - Street 1:2200 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:LA CANADA
Practice Address - State:CA
Practice Address - Zip Code:91011-1413
Practice Address - Country:US
Practice Address - Phone:818-790-1103
Practice Address - Fax:818-949-4981
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG80642207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW13760Medicare ID - Type Unspecified
CAG44201Medicare UPIN