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NPI Code Detail

MEDICARE: ANNA PETROV DPM SC

MEDICARE: ANNA PETROV DPM SC
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
1213E00000XPodiatrist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11626058OTHERILBCBS

General Provider Information

NPI Number : 1386667269
Entity Type Code : Organization
Provider Name (Legal Business Name) : ANNA PETROV DPM SC
Provider Business Mailing Address
First Line : 4108 N SHERIDAN RD
Second Line :
City : CHICAGO
State : IL
Zip : 60613-2007
Country : US
Telephone Number : 773-244-6517
Fax Number : 773-244-6531
Provider Business Practice Location Address
First Line : 4108 N SHERIDAN RD
Second Line :
City : CHICAGO
State : IL
Zip : 60613-2007
Country : US
Telephone Number : 773-244-6517
Fax Number : 773-244-6531
Authorized Official
Title or Position : PRESIDENT
Name : ANNA PETROV
Credential : DPM
Telephone Number : 773-244-6517
Provider Enumeration Date : 07/25/2006
Last Update Date : 05/13/2013

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Directions to “ANNA PETROV DPM SC ” Practice Location

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