Individual
MICHAEL J PETRUSO
Active
Individual
MICHAEL J PETRUSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
6283
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1336112382
SMA MEDICAID
NV
05
—
2019102
—
NV
01
—
V108716
SMA MEDICARE
NV
01
—
V24262
LAB
NV
01
—
VWCGZT
MEDICARE GROUP
NV
Enumeration date
02/09/2006
Last updated
10/28/2014
Update your record
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