Provider Demographics
NPI:1881701282
Name:PETRO, NANCY BERKAS (MD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:BERKAS
Last Name:PETRO
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 1:4111 W MITCHELL ST STE 300
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-1748
Mailing Address - Country:US
Mailing Address - Phone:414-385-8800
Mailing Address - Fax:414-671-8860
Practice Address - Street 1:4111 W MITCHELL ST STE 300
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-1748
Practice Address - Country:US
Practice Address - Phone:414-385-8800
Practice Address - Fax:414-671-8860
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI22492208600000X
WI22492-202083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30511300Medicaid
WI30511300Medicaid
AP8894013OtherDEA NUMBER
013250048Medicare ID - Type UnspecifiedMEDICARE PROVIDER