Provider Demographics
NPI:1619005188
Name:PETROVIC, OLGA MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:OLGA
Middle Name:MARIE
Last Name:PETROVIC
Suffix:
Gender:F
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:P.O. BOX 236
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47006-0236
Mailing Address - Country:US
Mailing Address - Phone:812-932-3371
Mailing Address - Fax:812-932-3506
Practice Address - Street 1:256 STATE ROAD 129 S
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:IN
Practice Address - Zip Code:47006-9236
Practice Address - Country:US
Practice Address - Phone:812-932-4700
Practice Address - Fax:812-933-5144
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01075306A207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0660655Medicaid
IN201283440Medicaid
KY64863343Medicaid
OHPE0595497Medicare ID - Type UnspecifiedMONTGOMERY OFFICE
KY64863343Medicaid
IN940080023Medicare PIN
OHPE0595495Medicare ID - Type UnspecifiedFINNEYTOWN OFFICE