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General NPI Number Information
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NPI Number | 1518014331
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Entity Type | Individual
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Provider Name | PETRA GHERAIBEH MD
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Gender | Female
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 11/03/2025
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Provider Practice Location Address
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Address Line | 6071 W OUTER DR SUITE # 1 MAIN
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City | DETROIT
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State | MI
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Zip | 48235
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Country | US
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Telephone | 313-966-1008
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Fax | 313-966-9510
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Provider Business Mailing Address
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Address Line | 6071 W OUTER DR STE 1
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City | DETROIT
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State | MI
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Zip | 48235-2624
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Country | US
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Telephone | 313-966-1008
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Fax | 313-966-9510
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 4301091043
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 81105
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 34052
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License Number State | SC
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