Provider Demographics
NPI:1952069163
Name:THRIVE INTERNAL MEDICINE
Entity Type:Organization
Organization Name:THRIVE INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/ EMPLOYEE
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:PETRUNGARO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-691-5999
Mailing Address - Street 1:400 SKOKIE BLVD STE 405
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-7904
Mailing Address - Country:US
Mailing Address - Phone:224-215-8585
Mailing Address - Fax:
Practice Address - Street 1:400 SKOKIE BLVD STE 405
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-7904
Practice Address - Country:US
Practice Address - Phone:224-215-8585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-04
Last Update Date:2021-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty