Individual
VAIDOTAS PETRUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5145 N CALIFORNIA AVE STE M276, CHICAGO, IL 60625-3661
(773) 878-8200
(773) 293-4171
Mailing address
2740 W FOSTER AVE, STE LL7, CHICAGO, IL 60625-3543
(773) 878-8200
(773) 293-4197
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
036118601
IL
208M00000X
Hospitalist Physician
Primary
036118601
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1619784
BCBS#
—
01
—
1620633
BCBS#
—
01
—
336079735
CONTROLLED SUBSTANCE
IL
Enumeration date
08/09/2007
Last updated
03/07/2023
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