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General NPI Number Information
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NPI Number | 1225167349
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Entity Type | Organization
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Legal Business Name | PAUL PETRE MD PC
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 24362 RENSSELAER ST
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City | OAK PARK
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State | MI
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Zip | 48237-1781
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Country | US
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Telephone | 313-673-9145
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Fax |
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Provider Business Mailing Address
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Address Line | 24362 RENSSELAER ST
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City | OAK PARK
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State | MI
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Zip | 48237-1781
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Country | US
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Telephone | 313-673-9145
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. PAUL M PETRE
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Credential | MD
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Telephone | 313-673-9145
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 4301078751
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License Number State | MI
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