Organization
PETRUNGARO PLASTIC SURGERY, LLC
Active
Organization
PETRUNGARO PLASTIC SURGERY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JASON M PETRUNGARO MD (PRESIDENT)
(219) 836-1163
Entity
Organization
Contact information
Practice address
800 MACARTHUR BLVD STE 21, MUNSTER, IN 46321-2918
(219) 836-1163
Mailing address
800 MACARTHUR BLVD STE 21, MUNSTER, IN 46321-2918
(219) 836-1163
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
01074460A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5410211
CIGNA
IN
01
—
914915
BCBS
IN
01
—
9183790
AETNA
IN
Enumeration date
12/05/2014
Last updated
05/08/2015
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