Provider Demographics
NPI:1407899198
Name:PETRICH, ADAM M (MD)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:M
Last Name:PETRICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:676 N. ST CLAIR, SUITE 850
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611
Mailing Address - Country:US
Mailing Address - Phone:312-695-6180
Mailing Address - Fax:312-695-4770
Practice Address - Street 1:676 N. ST CLAIR, SUITE 2100
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:312-695-6180
Practice Address - Fax:312-695-4770
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1567207R00000X
IL036128178207RX0202X
IL036.128178207RX0202X, 207RH0003X
IL336.089386207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology