Individual
MATTHEW JAMES PETRUSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DD
Contact information
Practice address
1000 HOUGHTON AVE, SAGINAW, MI 48602-5303
(989) 746-7518
(989) 746-7580
Mailing address
1000 HOUGHTON AVE, SAGINAW, MI 48602-5303
(989) 746-7518
(989) 746-7580
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
02007641A
IN
207P00000X
Emergency Medicine Physician
Primary
5101024425
MI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300092044
—
IN
Enumeration date
04/10/2017
Last updated
05/28/2025
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