MEDICARE: PETRUSKE CONSULTING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1356201206
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PETRUSKE CONSULTING LLC

Provider Business Mailing Address
First Line	:	14545 W GRAND AVE STE 109
Second Line	:
City	:	SURPRISE
State	:	AZ
Zip	:	85374-7279
Country	:	US
Telephone Number	:	623-600-9000
Fax Number	:	623-600-9001

Provider Business Practice Location Address
First Line	:	14545 W GRAND AVE STE 109
Second Line	:
City	:	SURPRISE
State	:	AZ
Zip	:	85374-7279
Country	:	US
Telephone Number	:	623-600-9000
Fax Number	:	623-600-9001

Authorized Official
Title or Position	:	OWNER
Name	:	MARY ANN PETRUSKE
Credential	:
Telephone Number	:	623-600-9000

Provider Enumeration Date	:	11/13/2025
Last Update Date	:	11/13/2025

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