MRS. ANTONIQUE PETERSON DO
NPI 1700377124
General Practice in Minneapolis, MN

Q: What is Antonique Peterson's NPI number?

The NPI number for Antonique Peterson is 1700377124. It was assigned to this individual provider in the NPPES registry on May 21, 2018.

Q: What is Antonique Peterson's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

Active since May 21, 2018PECOS EnrolledAccepts Medicare Assignment

1313 PENN AVE N, MINNEAPOLIS, MN 55411(612) 543-2500 Get Directions Write a Review

NPPES record last updated: October 27, 2021. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Mrs. Antonique Peterson Do NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MRS. ANTONIQUE PETERSON DO (NPI 1700377124) is an individual general practice provider in Minneapolis, Minnesota, licensed in Minnesota (69440) and active in the NPI registry since May 2018. She is enrolled in Medicare PECOS and is a graduate of Arizona College Of Osteopathic Medicine Mid Western University (2018).

NPPES Registry Identity

NPI1700377124

Entity TypeIndividualFemale

Primary Taxonomy208D00000X

Provider Legal NameMRS. ANTONIQUE PETERSONCredential: DO

Location Address1313 PENN AVE NMinneapolis, MN 55411-3047

Mailing Address1313 Penn Ave NMinneapolis, MN 55411-3047 · (612) 543-2582

Phone(612) 543-2500

Sole ProprietorNo

Medical School CMSArizona College Of Osteopathic Medicine Mid Western UniversityGraduated 2018

Enumeration DateMay 21, 2018

Last NPPES UpdateOctober 27, 2021

NPPES CertifiedOctober 27, 2021

✔ NPI 1700377124 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians

Taxonomy Code208D00000X

License✔ Licensed in MN · 69440

Definition

A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee

Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X

1313 PENN AVE N, Minneapolis, MN 55411

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Other Identifiers 1

Medicaid416005801MN

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Mrs. Antonique Peterson Do is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID7719375658

PECOS Enrollment IDI20260520004031

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. JOSHUA SABIN PSYD, LP

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