MEDICARE: KATE PETTY M.D.

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	207L00000X	Anesthesiology Physician	65254	AZ
2	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	65254	AZ
3	207LC0200X	Critical Care Medicine (Anesthesiology) Physician	MD472549	PA
4	207LC0200X	Critical Care Medicine (Anesthesiology) Physician	65254	AZ
5	207L00000X	Anesthesiology Physician	A185984	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P300461549404	OTHER	MI	DRIVER LICENSE

General Provider Information

NPI Number	:	1780046276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATE PETTY M.D.

Provider Business Mailing Address
First Line	:	521 PARNASSUS AVE, 4TH FLOOR, ROOM 4615
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94143
Country	:	US
Telephone Number	:	415-476-9035
Fax Number	:	415-353-9613

Provider Business Practice Location Address
First Line	:	521 PARNASSUS AVE, 4TH FLOOR, ROOM 4615
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94143
Country	:	US
Telephone Number	:	415-476-9035
Fax Number	:	415-353-9613

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

Provider Enumeration Date	:	03/23/2016
Last Update Date	:	09/29/2023

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Directions to “ KATE PETTY M.D.” Practice Location

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