Healthcare Provider Details

I. General information

NPI: 1548059785
Provider Name (Legal Business Name): GABRIELA DANIEL PETROVA
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2025
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 S ARLINGTON HEIGHTS RD STE 185
ARLINGTON HEIGHTS IL
60005-4172
US

IV. Provider business mailing address

770 WHALOM LN
SCHAUMBURG IL
60173-5926
US

V. Phone/Fax

Practice location:
  • Phone: 773-807-7590
  • Fax:
Mailing address:
  • Phone: 773-807-7590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number085.011366
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number085011366
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085011366
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number085011366
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: