Most Relevant Information
Provider Data
| NPI Number: | 1003270422 |
| Provider Name: | MICHAEL PETRY |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 04/12/2016 |
| Last Updated: | 12/08/2021 |
Provider Practice Location
6411 VETERANS MEMORIAL PKWY
CRESTWOOD
KY
400148698
Practice Location Phone/Fax
| Phone: | 5022418611 |
| Fax: | 5022414175 |
Provider Mailing Location
PO BOX 776351
CHICAGO
IL
606776351
Provider Mailing Phone/Fax
| Phone: | 5025599407 |
| Fax: | 5022725339 |