Individual
MICHAEL PETRUCCI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2222 N NEVADA AVE, COLORADO SPRINGS, CO 80907-6819
(719) 593-1799
(719) 265-3794
Mailing address
PO BOX 2989, COLORADO SPRINGS, CO 80901-2989
(719) 593-1799
(719) 265-3794
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
DR.0054385
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
39020000X
MONMOUTH
NJ
Enumeration date
07/17/2007
Last updated
08/25/2016
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