Healthcare Provider Details

I. General information

NPI: 1295819498
Provider Name (Legal Business Name): ANNA PETRYK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 DELAWARE STREET SE PWB FOURTH FLOOR, ROOM 4-100
MINNEAPOLIS MN
55455
US

IV. Provider business mailing address

420 DELAWARE STREET UNIVERSITY OF MINNESOTA PHYSICIANS
MINNEAPOLIS MN
55455
US

V. Phone/Fax

Practice location:
  • Phone: 612-626-6777
  • Fax:
Mailing address:
  • Phone: 612-626-6777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number41703
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: