Individual
DR. NICHOLAS ROMAN PETTIT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O., PH.D.
Contact information
Practice address
1701 N SENATE BLVD RM AG012, DEPARTMENT OF EMERGENCY MEDICINE, INDIANAPOLIS, IN 46202-1239
(317) 962-5974
(317) 963-5394
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
02005159A
IN
390200000X
Student in an Organized Health Care Education/Training Program
11018903A
IN
Other
Enumeration date
06/09/2016
Last updated
04/06/2021
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