Provider Demographics
NPI:1508168436
Name:J.M. PETIT, M.D. P.S.C.
Entity Type:Organization
Organization Name:J.M. PETIT, M.D. P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:PETIT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-781-0431
Mailing Address - Street 1:20 N GRAND AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FORT THOMAS
Mailing Address - State:KY
Mailing Address - Zip Code:41075-4106
Mailing Address - Country:US
Mailing Address - Phone:859-781-0431
Mailing Address - Fax:859-781-0473
Practice Address - Street 1:20 N GRAND AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:FORT THOMAS
Practice Address - State:KY
Practice Address - Zip Code:41075-4106
Practice Address - Country:US
Practice Address - Phone:859-781-0431
Practice Address - Fax:859-781-0473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-29
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Single Specialty