Individual
ANNA M PETROV
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
4108 N SHERIDAN RD, CHICAGO, IL 60613-2007
(773) 244-6517
(773) 244-6531
Mailing address
4108 N SHERIDAN RD, CHICAGO, IL 60613-2007
(773) 244-6517
(773) 244-6531
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
016004935
IL
213ES0131X
Foot Surgery Podiatrist
Primary
016004935
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016004935
—
IL
01
—
1626058
BC/BS
—
Enumeration date
11/10/2005
Last updated
05/13/2013
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