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1134125164

NPI Code Detail

MEDICARE: ANNE M PETRE MD

MEDICARE: ANNE M PETRE 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	207Q00000X	Family Medicine Physician	036091695	IL
2	207P00000X	Emergency Medicine Physician	036-091695	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	020355	OTHER		HEALTH ALLIANCE
2	IL01F1	OTHER		JOHN DEERE
3	20083	OTHER		IOWA HEALTH SOLUTIONS
4	90800	OTHER		WELLMARK BC/BS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	4796890020	OTHER		DMERC

General Provider Information

NPI Number	:	1134125164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNE M PETRE MD

Provider Business Mailing Address
First Line	:	306 46TH AVE
Second Line	:
City	:	EAST MOLINE
State	:	IL
Zip	:	61244-4281
Country	:	US
Telephone Number	:	309-796-2329
Fax Number	:	309-796-1146

Provider Business Practice Location Address
First Line	:	306 46TH AVE
Second Line	:
City	:	EAST MOLINE
State	:	IL
Zip	:	61244-4281
Country	:	US
Telephone Number	:	309-796-2329
Fax Number	:	309-796-1146

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

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	09/04/2015

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Directions to “ ANNE M PETRE MD” Practice Location

Language	Start Address	Practice Location

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