Individual
MICHAEL PETRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6411 VETERANS MEMORIAL PKWY, CRESTWOOD, KY 40014-8698
(502) 241-8611
(502) 241-4175
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6351
(502) 559-9407
(502) 272-5339
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
R4220
KY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/12/2016
Last updated
12/08/2021
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