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NPI Code Detail

MEDICARE: MICHAEL PETRI CRNA

MEDICARE: MICHAEL PETRI CRNA
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
1367500000XCertified Registered Nurse Anesthetist285765NY
2367500000XCertified Registered Nurse AnesthetistARNP 9263613FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1G4381OTHERFLFLORIDA BCBS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1629078878
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL PETRI CRNA
Provider Business Mailing Address
First Line : 421 SE OSCEOLA ST # 3
Second Line : PO BOX 868
City : STUART
State : FL
Zip : 34994-2505
Country : US
Telephone Number : 772-286-0338
Fax Number : 772-287-1139
Provider Business Practice Location Address
First Line : 200 SE HOSPITAL AVE
Second Line : ANESTHESIA DEPARTMENT
City : STUART
State : FL
Zip : 34994-2346
Country : US
Telephone Number : 772-286-0338
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/29/2005
Last Update Date : 05/16/2008

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