Provider Demographics
NPI:1437343183
Name:PETROVIC, MARKO (MD)
Entity Type:Individual
Prefix:MR
First Name:MARKO
Middle Name:
Last Name:PETROVIC
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 1:3090 VICENTE ST
Mailing Address - Street 2:APARTMENT #105
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94116-2761
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:400 PARNASSUS AVENUE
Practice Address - Street 2:A837
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-0348
Practice Address - Country:US
Practice Address - Phone:415-731-3376
Practice Address - Fax:415-731-3376
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA97937204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM