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NPI Code Detail

MEDICARE: ANNA M PETROV DPM

MEDICARE: ANNA M PETROV DPM
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
1213E00000XPodiatrist016004935IL
2213ES0131XFoot Surgery Podiatrist016004935IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11626058OTHERBC/BS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1407837040
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANNA M PETROV DPM
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 :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/10/2005
Last Update Date : 05/13/2013

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Directions to “ ANNA M PETROV DPM” Practice Location

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