Individual
MICHAEL PETRU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
6810 STATE ROUTE 162, SUITE 215, MARYVILLE, IL 62062-8501
(618) 288-5711
Mailing address
1836 LACKLAND HILL PKWY, ATTNT CREDENTIALING DEPART, SAINT LOUIS, MO 63146-3572
(314) 989-0300
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
340628294001
—
IL
Enumeration date
12/11/2006
Last updated
02/19/2008
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