Individual
MICHAEL PETIKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1970 ROANOKE BLVD, SALEM, VA 24153-6404
(540) 982-2463
Mailing address
1970 ROANOKE BLVD, SALEM, VA 24153-6404
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
Primary
1244484
VA
363L00000X
Nurse Practitioner
0024191604
VA
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
08/15/2019
Last updated
02/25/2026
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