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NPI Code Detail

MEDICARE: JAMES E PETRE MD

MEDICARE: JAMES E PETRE MD
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
1207Q00000XFamily Medicine Physician036091692IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1020356OTHERHEALTH ALLIANCE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
320084OTHERIOWA HEALTH SOLUTIONS
490722OTHERWELLMARK BC/BS
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
64796890020OTHERDMERC

General Provider Information

NPI Number : 1619973989
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES E PETRE MD
Provider Business Mailing Address
First Line : 865 LINCOLN RD
Second Line : STE L10
City : BETTENDORF
State : IA
Zip : 52722-4159
Country : US
Telephone Number : 563-355-9191
Fax Number : 563-355-3419
Provider Business Practice Location Address
First Line : 306 46TH AVE
Second Line :
City : EAST MOLINE
State : IL
Zip : 61244-4281
Country : US
Telephone Number : 309-796-2329
Fax Number : 309-796-1146
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2005
Last Update Date : 09/23/2022

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