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NPI Code Detail

MEDICARE: CARA A PETRI PA-C

MEDICARE: CARA A PETRI PA-C
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
1363A00000XPhysician Assistant1880WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1508848755
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARA A PETRI PA-C
Provider Business Mailing Address
First Line : PO BOX 735044
Second Line :
City : CHICAGO
State : IL
Zip : 60673-5044
Country : US
Telephone Number : 800-326-2250
Fax Number :
Provider Business Practice Location Address
First Line : 215 WASHINGTON ST
Second Line :
City : GRAFTON
State : WI
Zip : 53024-1700
Country : US
Telephone Number : 262-375-3700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/15/2005
Last Update Date : 07/11/2024

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Directions to “ CARA A PETRI PA-C” Practice Location

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