Provider Demographics
NPI:1609827070
Name:PETKOVICH, FRANK O (MD)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:O
Last Name:PETKOVICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2821 N BALLAS RD
Mailing Address - Street 2:SUITE C70
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-2321
Mailing Address - Country:US
Mailing Address - Phone:314-432-6500
Mailing Address - Fax:314-432-6502
Practice Address - Street 1:2821 N BALLAS RD
Practice Address - Street 2:SUITE C70
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2321
Practice Address - Country:US
Practice Address - Phone:314-432-6500
Practice Address - Fax:314-432-6502
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR5882207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO87732OtherGROUP HEALTH PLAN
MOP00137920OtherRAILROAD MEDICARE
MO4134958OtherAETNA
MO101822OtherHEALTHLINK
MO0900089OtherUNITED HEALTHCARE
MO3137743003OtherCIGNA
MO26897OtherBLUE CROSS BLUE SHIELD
MO4134958OtherAETNA
MO0900089OtherUNITED HEALTHCARE