Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 036111893 | IL |
Y | 208600000X | Surgeon | 036111893 | IL |
N | 2086S0127X | Trauma Surgeon | 036-111893 | IL |
NPI | 1487612297 |
---|---|
Provider Name | Dr. Peter Bill Petratos |
First Address | Naperville, IL 60540-6535 |
Second Address | Naperville, IL 60540-6535 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2006 |
Last Update Date | 15/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I23369 | (02) |