Organization
STEVEN PERETIATKO MD A MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEVEN PERETIATKO MD (OWNER)
(941) 236-0461
Entity
Organization
Contact information
Practice address
1303 MABLE AVE, MODESTO, CA 95355-1119
(209) 857-3400
(812) 479-7865
Mailing address
PO BOX 5705, EVANSVILLE, IN 47716-5705
(812) 492-1960
(812) 479-7865
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A190660
MEDICAL LICENSE
CA
Enumeration date
03/20/2024
Last updated
05/04/2026
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