Healthcare Provider Details

I. General information

NPI: 1588669188
Provider Name (Legal Business Name): ALISON PETROVICH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALISON GLENDENING MD

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10215 BROADWAY
CROWN POINT IN
46307-8001
US

IV. Provider business mailing address

8558 BROADWAY
MERRILLVILLE IN
46410-7032
US

V. Phone/Fax

Practice location:
  • Phone: 219-661-6152
  • Fax: 219-703-6833
Mailing address:
  • Phone: 219-392-7084
  • Fax: 219-703-6854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01054379
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: