Individual
MICHAEL PETRUSCHAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
736 BATTLEFIELD BLVD N, CHESAPEAKE, VA 23320-4941
(757) 312-8121
Mailing address
PO BOX 1707, CHESAPEAKE, VA 23327-1707
(757) 366-0101
(757) 366-8792
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
0101237966
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01011237966
MEDICAL LICENSE
VA
05
—
010159156
—
VA
Enumeration date
08/03/2006
Last updated
07/08/2007
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