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General NPI Number Information
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NPI Number | 1447783022
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Entity Type | Individual
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Provider Name | MATTHEW JAMES PETRUSO DD
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Gender | Male
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Dates
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Enumeration Date | 04/10/2017
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Last Update Date | 05/28/2025
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Provider Practice Location Address
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Address Line | 1000 HOUGHTON AVE
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City | SAGINAW
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State | MI
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Zip | 48602-5303
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Country | US
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Telephone | 989-746-7518
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Fax | 989-746-7580
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Provider Business Mailing Address
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Address Line | 1000 HOUGHTON AVE
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City | SAGINAW
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State | MI
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Zip | 48602-5303
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Country | US
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Telephone | 989-746-7518
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Fax | 989-746-7580
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 5101024425
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 02007641A
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License Number State | IN
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