Individual
DR. JASON MICHAEL PETRUNGARO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
800 MACARTHUR BLVD, SUITE 21, MUNSTER, IN 46321-2917
(219) 836-1163
(844) 270-6677
Mailing address
800 MACARTHUR BLVD, SUITE 21, MUNSTER, IN 46321-2917
(219) 836-1163
(844) 270-6677
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
01074460A
IN
2086S0122X
Plastic and Reconstructive Surgery Physician
N9993
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0914915
BCBS IN
IN
01
—
8DT481
BLUE CROSS BLUE SHIELD
TX
01
—
MEDICARE
IN2244001
IN
01
—
P01602561
RR MEDICARE
IN
Enumeration date
03/28/2008
Last updated
08/03/2016
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