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NPI Code Detail

MEDICARE: MICHAEL PETRIE

MEDICARE: MICHAEL PETRIE
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1669980975
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL PETRIE
Provider Business Mailing Address
First Line : 117 HEALTH SCIENCES BLDG 3640 COLONEL GLENN HWY
Second Line :
City : DAYTON
State : OH
Zip : 45435-0001
Country : US
Telephone Number : 937-775-3458
Fax Number : 937-775-3434
Provider Business Practice Location Address
First Line : 9 N EDWIN C MOSES BLVD
Second Line :
City : DAYTON
State : OH
Zip : 45402-8470
Country : US
Telephone Number : 937-775-4300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/21/2018
Last Update Date : 01/21/2018

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Directions to “ MICHAEL PETRIE ” Practice Location

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