MEDICARE: DR. ROBERT E. PETRAS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	35046333P	OH
2	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	235446-1	NY
3	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	25MA07940700	NJ
4	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	33830	AZ
5	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	4301084916	MI
6	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	MD421441	PA
7	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	ME92774	FL

General Provider Information

NPI Number	:	1134105661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT E. PETRAS MD

Provider Business Mailing Address
First Line	:	14275 MIDWAY RD
Second Line	:	SUITE 400
City	:	ADDISON
State	:	TX
Zip	:	75001-3614
Country	:	US
Telephone Number	:	214-932-8018
Fax Number	:	610-271-4245

Provider Business Practice Location Address
First Line	:	7730 FIRST PL
Second Line	:	SUITE A
City	:	OAKWOOD VILLAGE
State	:	OH
Zip	:	44146-6719
Country	:	US
Telephone Number	:	800-331-7546
Fax Number	:	440-703-2155

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/16/2005
Last Update Date	:	12/02/2013

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Directions to “ DR. ROBERT E. PETRAS MD” Practice Location

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