Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 4301100399 | MI |
N | 111NI0900X | Internist | 4301100399 | MI |
NPI | 1003179623 |
---|---|
Provider Name | Dr. Christopher Michael Petrilli |
First Address | Ann Arbor, MI 48108 |
Second Address | Ann Arbor, MI 48109-5352 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2012 |
Last Update Date | 31/05/2018 |