MEDICARE: CHELSEY ANN PETZ 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
1	207R00000X	Internal Medicine Physician	36991	NE
2	207R00000X	Internal Medicine Physician	35.123317	OH
3	207R00000X	Internal Medicine Physician	LL32005	SC
4	207R00000X	Internal Medicine Physician	32005	SC

General Provider Information

NPI Number	:	1700014677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHELSEY ANN PETZ MD

Provider Business Mailing Address
First Line	:	7261 MERCY RD
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68124-2311
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5002 UNDERWOOD AVE
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68132-2236
Country	:	US
Telephone Number	:	402-717-0785
Fax Number	:	402-717-4905

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2009
Last Update Date	:	12/08/2025

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