Provider Demographics
NPI:1346260973
Name:PETROZZI, MARIANA C (MD)
Entity Type:Individual
Prefix:
First Name:MARIANA
Middle Name:C
Last Name:PETROZZI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST STE 500
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8040 CLEARVISTA PKWY STE 460
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-4673
Practice Address - Country:US
Practice Address - Phone:317-621-1754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301111970207RP1001X
OH35-076664207RC0200X
IN01093316A207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH290014924OtherRAILROAD MEDICARE
OH000000539513OtherANTHEM
OH7853338OtherAETNA
OH000000224315OtherUNISON
OH363911OtherWELLCARE
OH744749OtherBUCKEYE
OHP00427399OtherRAILROAD MEDICARE
OH2328369Medicaid
OH7853338OtherAETNA
OH000000224315OtherUNISON
OHP00427399OtherRAILROAD MEDICARE
H59956Medicare UPIN