Healthcare Provider Details

I. General information

NPI: 1730151846
Provider Name (Legal Business Name): JOHN J PETRUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3347 REVERE RD
RICHFIELD OH
44286-9705
US

IV. Provider business mailing address

PO BOX 74589
CLEVELAND OH
44194-4589
US

V. Phone/Fax

Practice location:
  • Phone: 330-461-9300
  • Fax: 330-867-1195
Mailing address:
  • Phone: 330-461-9300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number35-05-2725
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: