Individual
DR. MICHAEL S PETRONACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
5679 147TH ST N, HUGO, MN 55038-9302
(651) 762-9545
(651) 762-9542
Mailing address
5679 147TH ST N, HUGO, MN 55038-9302
(651) 762-9545
(651) 762-9542
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2544
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3868206-00
—
MN
Enumeration date
12/29/2006
Last updated
06/27/2013
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