Provider Demographics
NPI:1417121054
Name:PETKAR, ANIMESH (MD)
Entity Type:Individual
Prefix:DR
First Name:ANIMESH
Middle Name:
Last Name:PETKAR
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 1:6767 NORTH FRESNO ST
Mailing Address - Street 2:STE 101
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710
Mailing Address - Country:US
Mailing Address - Phone:559-432-1000
Mailing Address - Fax:559-432-1034
Practice Address - Street 1:6767 NORTH FRESNO AVE, # 101
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-3329
Practice Address - Country:US
Practice Address - Phone:559-432-1000
Practice Address - Fax:559-432-1034
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR184359207W00000X
FL119840207W00000X
TN48379207W00000X
ARE7446207W00000X
CAA131108207W00000X
WA60462016207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology