Provider Demographics
NPI:1689841801
Name:PETROVAS MEDICAL CENTER, S.C
Entity Type:Organization
Organization Name:PETROVAS MEDICAL CENTER, S.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEMTRIOS
Authorized Official - Middle Name:
Authorized Official - Last Name:PETROVAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-989-0585
Mailing Address - Street 1:5962 N LINCOLN AVE STE 12
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-3762
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5962 N LINCOLN AVE STE 12
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-3762
Practice Address - Country:US
Practice Address - Phone:773-989-0585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042007949261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty