Provider Demographics
NPI:1750536454
Name:PAUL PETRE MD PC
Entity type:Organization
Organization Name:PAUL PETRE MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:PETRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-573-6400
Mailing Address - Street 1:30781 STEPHENSON HWY
Mailing Address - Street 2:
Mailing Address - City:MADISON HTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-1618
Mailing Address - Country:US
Mailing Address - Phone:248-284-2316
Mailing Address - Fax:248-583-8969
Practice Address - Street 1:28800 RYAN RD
Practice Address - Street 2:SUITE 300
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-4272
Practice Address - Country:US
Practice Address - Phone:586-573-6400
Practice Address - Fax:586-573-1918
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PAUL PETRE MD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-21
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier