Provider Demographics
NPI:1821398769
Name:PETRE, MARK (DPM)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:PETRE
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:4260 GLENDALE MILFORD RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-3763
Mailing Address - Country:US
Mailing Address - Phone:513-769-4408
Mailing Address - Fax:513-769-4578
Practice Address - Street 1:4260 GLENDALE MILFORD RD
Practice Address - Street 2:SUITE 103
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-3763
Practice Address - Country:US
Practice Address - Phone:513-769-4408
Practice Address - Fax:513-769-4578
Is Sole Proprietor?:No
Enumeration Date:2010-10-26
Last Update Date:2013-09-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH003652213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery