Individual
SCOTT W PETRESCUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1720 HIGHWAY 59 S, THIEF RIVER FALLS, MN 56701-4331
(218) 684-4747
Mailing address
1720 HIGHWAY 59 S, THIEF RIVER FALLS, MN 56701-4331
(218) 684-4747
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
41217
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10928
—
ND
05
—
945324500
—
MN
Enumeration date
09/30/2006
Last updated
11/18/2011
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