Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Kenneth R. Petersen, MD

Individual provider Internal Medicine Physician · NPI 1912017104

Kenneth R. Petersen, MD is an Internal Medicine in Glendale, Arizona. Graduated from University of Illinois College of Med (CHI/PEOR/ROCK/Chm-Urb) in 1983, 43 years ago. Practices with Banner Primary Care Physicians Arizona LLC, a 237-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Arizona.

Years since qualifying
43
Trained at
University of Illinois College of Med (CHI/PEOR/ROCK/Chm-Urb)
Licensed in
AZ
In the registry since
2006
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

7701 W Aspera Blvd
Glendale, AZ 85308-7947
Phone: (623) 465-6060
Fax: (623) 242-5833
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Internal Medicine Physician (primary) Taxonomy 207R00000X · Licence 64419 (AZ)

Record details

NPI number1912017104
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedAugust 30, 2006
Last updated in NPPESOctober 1, 2025
Certification dateOctober 1, 2025
Mailing address7701 W Aspera Blvd Ste 201, Glendale, AZ 85308-7947

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyINTERNAL MEDICINE
Medical schoolUNIVERSITY OF ILLINOIS COLLEGE OF MED (CHI/PEOR/ROCK/CHM-URB)
Graduated 1983 (43 years in practice)
Group practice Banner Primary Care Physicians Arizona Llc — 237 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations3 on file with Medicare

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