Petrak, Channing
Petrak, Channing is an individual health care provider with primary practice located at Dept Of Pediatrics 320 E Armstrong, Peoria IL 61603. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as her primary health care specialty. Petrak, Channing can be contacted via phone (309) 624-9587.Contact Information
Primary practice address
Dept Of Pediatrics 320 E Armstrong
Peoria IL 61603
Phone: (309) 624-9587
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | 036108511 | Illinois |
Profile Details
| NPI number | 1952370538 |
|---|---|
| LBN Legal business name | Petrak, Channing |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 16th, 2006 |
| Last updated | Jul 22nd, 2013 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1952370538 | NPPES |
| Illinois | MEDICAID | 036108511 | |
| Illinois | Other | 639810 | |
| Illinois | Other | 07215036 | |
| Illinois | Other | IL01CN |
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