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

Michael Jake Petersen, MD

Individual provider Pediatric Sports Medicine Physician · NPI 1780248146

Michael Jake Petersen, MD is a Sports Medicine in Seattle, Washington. Graduated from Rush Medical College of Rush University in 2021, 5 years ago. Practices as a sole proprietor. Licensed in Washington.

Years since qualifying
5
Trained at
Rush Medical College of Rush University
Licensed in
WA
In the registry since
2019
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

3800 Montlake Blvd
Seattle, WA 98195-0007
Phone: (206) 520-5000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Pediatric Sports Medicine Physician (primary) Taxonomy 2080S0010X · Licence MD.MD.61679347 (WA)

Record details

NPI number1780248146
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorYes
NPI enumeratedApril 30, 2019
Last updated in NPPESApril 11, 2026
Certification dateApril 11, 2026

Medicare enrollment

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

Medicare specialtySPORTS MEDICINE
Also practisesPEDIATRIC MEDICINE
Medical schoolRUSH MEDICAL COLLEGE OF RUSH UNIVERSITY
Graduated 2021 (5 years in practice)
Accepts Medicare assignment Not indicated

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