Individual
PETRA JOSEPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1030 N CLARK ST, CHICAGO, IL 60610-5467
(312) 238-7800
Mailing address
36912 EAGLE WAY, CHICAGO, IL 60678-0001
(407) 681-2241
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
036-061158
IL
208100000X
Physical Medicine & Rehabilitation Physician
036-061158
IL
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
036-061158
IL
208VP0000X
Pain Medicine Physician
036-061158
IL
208VP0014X
Interventional Pain Medicine Physician
036-061158
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036061158
—
IL
01
—
250011935
RAILROAD MEDICARE
IL
01
—
250011936
RAILROAD MEDICARE
IL
Enumeration date
08/31/2006
Last updated
02/26/2008
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