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NPI Code Detail

MEDICARE: EMILY MARIE PETRUCCI

MEDICARE: EMILY MARIE PETRUCCI
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 ProgramIL

General Provider Information

NPI Number : 1932056181
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMILY MARIE PETRUCCI
Provider Business Mailing Address
First Line : 2822 S EMERALD AVE FL 2
Second Line :
City : CHICAGO
State : IL
Zip : 60616-2529
Country : US
Telephone Number : 630-247-4498
Fax Number :
Provider Business Practice Location Address
First Line : 1853 W POLK ST
Second Line :
City : CHICAGO
State : IL
Zip : 60612-4355
Country : US
Telephone Number : 312-996-2450
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2026
Last Update Date : 03/16/2026

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Directions to “ EMILY MARIE PETRUCCI ” Practice Location

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