Provider Demographics
NPI:1578959946
Name:PETRIE, TIMOTHY GERARD JR (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:GERARD
Last Name:PETRIE
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:7255 OLD OAK BLVD STE C208
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-3300
Mailing Address - Country:US
Mailing Address - Phone:440-816-4647
Mailing Address - Fax:440-243-8480
Practice Address - Street 1:7255 OLD OAK BLVD STE C208
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-3300
Practice Address - Country:US
Practice Address - Phone:440-816-4647
Practice Address - Fax:440-243-8480
Is Sole Proprietor?:No
Enumeration Date:2015-04-12
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.148501207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology